{ "hospital_name": "Saint Michaels Medical Center", "last_updated_on": "2026-09-01", "version": "3.0", "location_name": [ "Saint Michaels Medical Center" ], "hospital_address": [ "111 Central Avenue Newark, NJ 07102" ], "license_information": { "license_number": "10713", "state": "NJ" }, "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": "Alan Sickles" }, "type_2_npi": [ "1568825545" ], "standard_charge_information": [ { "description": "RENAL FAILURE WITHOUT CCMCC", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10143, "minimum": 3869.09, "maximum": 18359.0472, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18359.05, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 18359.05, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8726.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8726.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10169.08 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9075.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 17243.3, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 17243.3, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 10650.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13186.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 16228.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 13268 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8726.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 3869.09 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 8726.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10143.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13526.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10143.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6302.87 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8726.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9900.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8726.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8714.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 10558.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 8964.88 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 13693.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8988.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8726.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 1025, "minimum": 425.8468, "maximum": 3194.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2174.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2174.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1639.35, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1066.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2051.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2051.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1077.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1436.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1641.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1589.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 820.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1384.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1056.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood/Lymph System Procedure", "code_information": [ { "code": "38999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1942.83, "discounted_cash": 511, "minimum": 21.83, "maximum": 1942.83, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1942.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 511.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1942.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1942.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1942.83 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 690.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 526.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1084.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1084.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 817.69, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 532.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1023.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1023.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 537.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 716.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 818.59, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 511.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 511.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 793.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 511.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 409.3, "additional_payer_notes": "80.00% of Medicare Rates" } ] } ] }, { "description": "Hc Braf Gene", "code_information": [ { "code": "81210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 894, "discounted_cash": 175, "minimum": 105.24, "maximum": 715.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 371.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 371.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 254.33, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 350.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 350.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 184.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 245.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 210.48, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 210.54, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 210.54, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.54, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 271.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 140.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 105.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 105.24 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 175.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 175.4 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 236.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 175.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [ { "code": "019", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 85056, "minimum": 68222.7, "maximum": 174298, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 153951.94, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 153951.94, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 68222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 68222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 120860.12 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 70951.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 144595.74, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 144595.74, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 89309.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 110573.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 136090.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 174298 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 68222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 68222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 85056.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 105745.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 85056.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 117877 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 68222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 117670.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 68222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 103572.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 125483.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 106548.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 114826.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 70269.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 68222.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Ulna Shaft Fx W Manip", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 286, "minimum": 133.1867, "maximum": 999.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remv Ext Canal Foreign Body", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.7, "discounted_cash": 154, "minimum": 21.83, "maximum": 571.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.59, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 246.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Echo Heart,Transesophageal,Complete - 93312 - 48300003", "code_information": [ { "code": "93312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2654.92, "discounted_cash": 633, "minimum": 353.9008, "maximum": 2123.936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1343.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1343.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1012.76, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1267.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1267.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 665.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 887.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1013.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1296.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1296.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1296.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 412.31, "10th_percentile": 412.31, "90th_percentile": 412.31, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 506.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1817 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1599 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1939 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1649 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 855.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 389.21, "10th_percentile": 389.21, "90th_percentile": 389.21, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Immuniz Admin, Oral/Nas, Ea Ad Vac", "code_information": [ { "code": "90474", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140, "minimum": 18.662, "maximum": 140, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 140 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 140 } ] } ] }, { "description": "Hc Bamlanivimab Infusion And Monitoring", "code_information": [ { "code": "M0239", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1548, "discounted_cash": 352, "minimum": 206.3484, "maximum": 1238.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 747.79, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 747.79, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 563.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 705.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 705.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 370.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 493.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 564.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 721.69, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 721.69, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 721.69, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 352.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 352.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 546.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 352.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 282.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 359 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 352.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 338 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 383 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 348 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 476.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 363.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 352.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ketone Bodies Serum Quantitative", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.85, "discounted_cash": 8, "minimum": 4.9, "maximum": 104.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.32, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 17.32, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 30.82, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 30.82, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.82, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 19.18, "10th_percentile": 19.18, "90th_percentile": 19.18, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Flumazenil Iv Soln 1 Mg/10Ml (0.1 Mg/Ml)", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "63323042410", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Drug Screen Quant Alcohols Biomarkers 1 Or 2 - G0480 - 31080321", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500, "discounted_cash": 114, "minimum": 4.5255, "maximum": 734.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 117.75, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 117.75, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.75, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "076", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12721, "minimum": 5148.79, "maximum": 23025.9331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23025.93, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 23025.93, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10774.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10774.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13978.89 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11205.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 21626.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 21626.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 13357.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16537.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 20354.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 20115 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 10774.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 5148.79 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 10774.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12721.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16700.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12721.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5748.27 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10774.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13610.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10774.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11979.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 14513.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 12323.54 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17174.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11097.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10774.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [ { "code": "077", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9688.32, "maximum": 32945, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 32945 }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 9688.32 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22993.1 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS - SOI : 1", "code_information": [ { "code": "2481", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6652.68, "maximum": 7317.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7317.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7317.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 7317.95, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 6652.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6652.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6652.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6652.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6852.26, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6652.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies Titer", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157, "discounted_cash": 11, "minimum": 6.7, "maximum": 125.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 23.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33647.54, "maximum": 37012.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37012.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 37012.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 37012.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 33647.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33647.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 33647.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 33647.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 34656.97, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 33647.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 4", "code_information": [ { "code": "5404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21717.6, "maximum": 23889.36, "payers_information": [ { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21717.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22369.13, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21717.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23889.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23889.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 23889.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 21717.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21717.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21717.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Oligoclonal Immunoglobulin", "code_information": [ { "code": "83916", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116, "discounted_cash": 27, "minimum": 15.4628, "maximum": 92.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 58.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.72, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 54.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 54.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 28.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 38.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 32.87 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 27.39 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.91 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Duplex Up Extrem Art Bilat", "code_information": [ { "code": "93930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1437, "discounted_cash": 276, "minimum": 191.5521, "maximum": 1437, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1437 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1275 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1437 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1259 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 271.19, "10th_percentile": 271.19, "90th_percentile": 271.19, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MALFUNCTION,REACTION,COMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE - SOI : 4", "code_information": [ { "code": "2064", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23894.76, "maximum": 26284.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26284.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26284.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 26284.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 23894.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23894.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23894.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23894.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24611.6, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23894.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR CHEST & RESPIRATORY TRAUMA - SOI : 4", "code_information": [ { "code": "1354", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25596.25, "maximum": 28155.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 28155.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28155.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 28155.87, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 25596.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25596.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25596.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25596.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26364.14, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 25596.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH,THROAT & CRANIALFACIAL DIAGNOSES - SOI : 4", "code_information": [ { "code": "1154", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21925.14, "maximum": 24117.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 24117.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24117.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 24117.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 21925.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21925.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21925.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21925.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22582.89, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21925.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Chromosome Analy:Amniotic", "code_information": [ { "code": "88269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2341, "discounted_cash": 173, "minimum": 104.2, "maximum": 1872.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 368.16, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 368.16, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 251.81, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 347.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 347.32, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 182.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 243.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 208.39 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 551.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 551.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 551.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 138.93, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 104.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 104.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 173.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 173.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.66, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient New Moderate Mdm 45-59 Minutes - G0463 - 76100004", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 831, "discounted_cash": 154, "minimum": 41.8562, "maximum": 790.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 327.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 295.8, "10th_percentile": 27.09, "90th_percentile": 415.5, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 308.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 204.9, "10th_percentile": 179.1, "90th_percentile": 249.3, "count": "141" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 86.73, "10th_percentile": 86.73, "90th_percentile": 86.73, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Injection For Spleen X-Ray", "code_information": [ { "code": "38200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 793.57, "minimum": 105.7829, "maximum": 793.57, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 793.57 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 793.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 793.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 793.57 } ] } ] }, { "description": "Hc Inj Nerv Blck, Intercostal, Mult, Regionl", "code_information": [ { "code": "64421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 1025, "minimum": 425.8468, "maximum": 3194.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2174.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2174.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1639.35, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1066.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2051.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2051.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1077.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1436.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1641.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1589.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 820.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1384.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1056.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Treat Toe Fracture", "code_information": [ { "code": "28525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19476, "discounted_cash": 3794, "minimum": 21.83, "maximum": 15580.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8044.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8044.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6064.57, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3984.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5312.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6071.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5881.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3035.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5122.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3908.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER BLADDER PROCEDURES - SOI : 3", "code_information": [ { "code": "4453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21169.77, "maximum": 23286.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23286.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23286.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 23286.75, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 21169.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21169.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21169.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21169.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21804.87, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21169.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Esmolol Hcl Inj 10 Mg/Ml", "drug_information": { "unit": 250, "type": "ML" }, "code_information": [ { "code": "99999065210", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Clsd Treat Prox Humerus Fx W Manip", "code_information": [ { "code": "23605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1864, "minimum": 811.4104, "maximum": 5458, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2980.37, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1939.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1958.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2610.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2983.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1491.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1920.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Lip,<1/2 Vert Height", "code_information": [ { "code": "40652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2213.1, "discounted_cash": 625, "minimum": 21.83, "maximum": 2213.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1325.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1325.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 999.62, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 650.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1250.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1250.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 656.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 875.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1000.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1279.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1279.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1279.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 625.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 625.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 969.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 625.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 500.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 625.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2213.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 844.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 625.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Biopsy Forearm Soft Tissues,Superfic", "code_information": [ { "code": "25065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1915, "minimum": 21.83, "maximum": 4946.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3622 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3861 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3280 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perc Radiofreq Ablate Renal Tumor", "code_information": [ { "code": "50592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20995.7, "discounted_cash": 7010, "minimum": 21.83, "maximum": 16796.56, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6697 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8130 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6905 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9464.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7221.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14863.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14863.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11205.21, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7291.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14021.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 14021.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 7361.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9815.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 11217.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 14344.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 14344.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 14344.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10867, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5608.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7623 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES- SOI : 1", "code_information": [ { "code": "1761", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20774.02, "maximum": 22851.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22851.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22851.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 22851.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 20774.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20774.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20774.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20774.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21397.24, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 20774.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ileoscopy Thru Stoma Biopsy Sing/Mult", "code_information": [ { "code": "44382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890, "discounted_cash": 1051, "minimum": 21.83, "maximum": 2890, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2229.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2229.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1681.06, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1093.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2103.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2103.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1104.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1472.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1682.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1630.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 841.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1419.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1083.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 3", "code_information": [ { "code": "1963", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11120.46, "maximum": 12232.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12232.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12232.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 12232.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 11120.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11120.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11120.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11120.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11454.07, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11120.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITHOUT CCMCC", "code_information": [ { "code": "337", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20859, "minimum": 10008.56, "maximum": 37754.9529, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37754.95, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 37754.95, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17237.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 17237.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 26002.9 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17926.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 35460.45, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 35460.45, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 21902.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27116.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 33374.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 32629 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17237.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10008.56 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 17237.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20859.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26717.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20859.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21041.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17237.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25316.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17237.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22283.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26997.58 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22923.69 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28159.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17754.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17237.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Injection Treatment Of Nerve", "code_information": [ { "code": "64681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 1025, "minimum": 21.83, "maximum": 3194.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2174.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2174.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1639.35, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1066.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2051.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2051.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1077.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1436.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1641.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1589.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 820.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1384.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1056.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remvl Perm Pm Plse Gen W/Repl Plse Gen Sngl Ld", "code_information": [ { "code": "33227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38022.7, "discounted_cash": 9596, "minimum": 21.83, "maximum": 30418.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20345.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20345.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15338.2, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9980.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 19193.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 19193.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 10076.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13435.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 15355.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 19635.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 19635.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 19635.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14875.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7677.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8705 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7645 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 9284 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 7882 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12955.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9884.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Exc Abd Les Sc < 3 Cm", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 1915, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Expose Femoral Art, Groin Incis Uni (Aaa Repr)", "code_information": [ { "code": "34812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3312, "minimum": 21.83, "maximum": 3312, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3312 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2090 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3312 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2155 } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21563, "minimum": 17796.4, "maximum": 39029.0481, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39029.05, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 39029.05, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17796.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 17796.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 27043.02 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 18508.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 36657.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 36657.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 22641.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28031.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 34500.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 33689 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17796.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 17796.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 21563.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27584.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21563.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23892 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17796.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26329.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17796.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23174.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 28077.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 23840.64 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29110.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18330.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17796.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Dist Fingr Fx Wo Manip Ea", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1055.42, "discounted_cash": 286, "minimum": 140.6875, "maximum": 1055.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1055.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1055.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1055.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1055.42 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27780, "minimum": 12890.71, "maximum": 50282.2887, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 50282.29, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 50282.29, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22734.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 22734.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 36229.58 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 23643.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 47226.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 47226.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 29169.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 36114.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 44448.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 45769 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 22734.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 12890.71 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 22734.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 27780.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35237.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27780.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29107.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 22734.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35273.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22734.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31047.51 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 37615.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 31939.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37503.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23416.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 22734.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "167", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23936, "minimum": 11845.72, "maximum": 43324.5039, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43324.5, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 43324.5, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19681.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19681.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 30549.6 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 20468.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 40691.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 40691.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 25133, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31117.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 38297.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 39681 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19681.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 11845.72 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 19681.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 23936.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30505.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23936.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22800.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19681.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29743.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19681.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26179.96 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 31718.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26931.98 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32313.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20271.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19681.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Ventr Pm W Transvenous Electrode", "code_information": [ { "code": "33207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47790.9, "discounted_cash": 12121, "minimum": 21.83, "maximum": 38232.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25696.8, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25696.8, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19372.47, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12605.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 24242.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 24242.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 12727.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16969.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 19393.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24799.83, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24799.83, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24799.83, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18787.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9696.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8705 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7645 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 9284 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 7882 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16363.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12484.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12121.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sex Chromatin Identification, Blood Smear", "code_information": [ { "code": "88140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.68, "discounted_cash": 7, "minimum": 4.79, "maximum": 95.744, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.59, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 9.59 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.39 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH CC", "code_information": [ { "code": "549", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17100, "minimum": 7766.89, "maximum": 30952.7919, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30952.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 30952.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14252.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14252.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20449.97 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14822.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29071.68, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 29071.68, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 17956.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22231.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 27361.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 26301 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14252.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.89 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 14252.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17100.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22091.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17100.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13607.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14252.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19910.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14252.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17524.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 21232.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 18028.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23086.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14680.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14252.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PROSTATECTOMY WITH CC", "code_information": [ { "code": "666", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23315, "minimum": 11105.99, "maximum": 42201.8695, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 42201.87, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 42201.87, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29633.14 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19956.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 39637.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 39637.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 24481.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30310.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 37305.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 37448 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 11105.99 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 19188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 23315.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29742.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23315.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24494.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28851.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19188.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25394.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 30766.69 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26124.05 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31476.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19764.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19188.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "251", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20394, "minimum": 10473.62, "maximum": 36914.5337, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36914.53, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 36914.53, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25316.83 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17543.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34671.11, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 34671.11, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 21414.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26513.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 32631.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 34602 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10473.62 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 16868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20394.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26146.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20394.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23547.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24648.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21695.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26285.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22318.86 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27532.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17374.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16868.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Removal of toe lesions - 28108 - ", "code_information": [ { "code": "28108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11540, "discounted_cash": 1864, "minimum": 21.83, "maximum": 9232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2980.37, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1939.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1958.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2610.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2983.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1491.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1920.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES - SOI : 3", "code_information": [ { "code": "3513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11780.47, "maximum": 12958.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12958.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12958.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 12958.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 11780.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11780.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11780.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11780.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12133.89, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11780.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Sodium Bicarbonate Inj 8.4% - 00409490034", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00409490034", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Assay Of Imipramine - 80335 - 30100017", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.78, "minimum": 16.66, "maximum": 175.392, "payers_information": [ { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.66 } ] } ] }, { "description": "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE - SOI : 4", "code_information": [ { "code": "8504", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 77967, "maximum": 85763.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 85763.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 85763.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 85763.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 77967, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 77967, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 77967, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 77967, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 80306.01, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 77967, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Eeg W/O Video By Tech 2-12 Hr Unmonitored", "code_information": [ { "code": "95705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1322.25, "discounted_cash": 250, "minimum": 176.2559, "maximum": 1322.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 530.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 530.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.2, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 500.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 500.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 262.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 350.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 400.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 388.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1322.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1322.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1322.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1322.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 338.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tte W Or Wo Fol Wcon, Stress - C8928 - 48300016", "code_information": [ { "code": "C8928", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3284.55, "discounted_cash": 909, "minimum": 437.8305, "maximum": 2627.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1927.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1927.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1452.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1818.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1818.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 954.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1272.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1454.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1409.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 727.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1817 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1599 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1939 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1649 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 936.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [ { "code": "674", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30072, "minimum": 14433.23, "maximum": 54430.4105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 54430.41, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 54430.41, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 24554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 39615.88 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 25536.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 51122.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 51122.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 31575.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 39093.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 48115.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 51944 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 24554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 14433.23 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 24554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 30072.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38059.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30072.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30346.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 24554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38570.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24554.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33949.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 41131.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 34924.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 40597.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25290.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 24554.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Delivery/Birthing Room Resuscitation", "code_information": [ { "code": "99465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2077, "minimum": 276.8641, "maximum": 2077, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2077 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2077 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2077 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2077 } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1652", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 56157.86, "maximum": 61773.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 61773.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 61773.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 61773.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 56157.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 56157.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 56157.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 56157.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 57842.59, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 56157.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Nm Identify Sentinel Node", "code_information": [ { "code": "38792", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 463, "minimum": 310.7969, "maximum": 2331.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 482.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 486.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 649.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 1032.23, "10th_percentile": 1032.23, "90th_percentile": 1032.23, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 718.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 370.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2331.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2331.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2331.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2331.56 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 341.81, "10th_percentile": 310.8, "90th_percentile": 341.81, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 625.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 170.9, "10th_percentile": 170.9, "90th_percentile": 170.9, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES- SOI : 1", "code_information": [ { "code": "0291", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25148.98, "maximum": 27663.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27663.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27663.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 27663.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 25148.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25148.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25148.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25148.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25903.45, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 25148.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA - SOI : 4", "code_information": [ { "code": "5134", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39868.39, "maximum": 43855.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 43855.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 43855.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 43855.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 39868.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39868.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 39868.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 39868.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 41064.44, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 39868.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 3", "code_information": [ { "code": "3463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15780.33, "maximum": 17358.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17358.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17358.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 17358.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 15780.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15780.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15780.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15780.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16253.74, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 15780.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Drain Finger Abscess,Complicated", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7256.1, "discounted_cash": 1915, "minimum": 21.83, "maximum": 5804.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Xylose Tolerance Test", "code_information": [ { "code": "84620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22, "discounted_cash": 12, "minimum": 2.9326, "maximum": 22, "payers_information": [ { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.91 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.91 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.72, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 22, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 1500-1999G W OR WO OTHER SIGNIFICANT CONDITION - SOI : 1", "code_information": [ { "code": "6141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11049.56, "maximum": 12154.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12154.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12154.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 12154.52, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 11049.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11049.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11049.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11049.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11381.05, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11049.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151, "discounted_cash": 10, "minimum": 6.44, "maximum": 120.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 35.56, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 35.56, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.56, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 10.74, "10th_percentile": 10.74, "90th_percentile": 10.74, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Infectious Agent Genotype Hepatitis B Virus", "code_information": [ { "code": "87912", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 885, "discounted_cash": 257, "minimum": 117.9705, "maximum": 708, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 545.79, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 545.79, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 373.3, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 514.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 514.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 270.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 360.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 308.94 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 208.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 208.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 399.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 205.96, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 257.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 257.45 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 205.96 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 347.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 265.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES - SOI : 3", "code_information": [ { "code": "2293", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29192.67, "maximum": 32111.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32111.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32111.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 32111.93, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 29192.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29192.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29192.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29192.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 30068.45, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 29192.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "URETHRAL STRICTURE", "code_information": [ { "code": "697", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15617, "minimum": 5992.78, "maximum": 28267.6207, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 28267.62, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 28267.62, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18257.93 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13597.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 26549.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 26549.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 16398.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20302.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 24987.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 24271 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 5992.78 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 13074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15617.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20265.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15617.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14896.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17776.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15646.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18956.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 16095.87 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21083.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13466.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13074.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ercp Destruction/Lithotripsy Calculi Any Method", "code_information": [ { "code": "43265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25507.2, "discounted_cash": 7040, "minimum": 21.83, "maximum": 20405.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14925.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14925.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7040.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7040.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11252.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7322.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14080.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 14080.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 7392.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9856.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 11264.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 14404.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 14404.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 14404.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7040.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 7040.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7040.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10912.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 7040.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7040.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5632.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7040.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9504.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7251.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7040.39, "additional_payer_notes": "100.00% 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": 13381, "minimum": 1350, "maximum": 24221.1847, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24221.18, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 24221.18, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11299, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11299, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14954.63 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11750.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 22749.18, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 22749.18, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 14050.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17396.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 21410.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "per diem", "standard_charge_dollar": 3489 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11299, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "per diem", "standard_charge_dollar": 1350 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 11299, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13381.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17513.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13381.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11299, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14560.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11299, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12815.61 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15526.69 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 13183.74 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18065.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11637.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11299, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc C-Reactive Protein", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.33, "discounted_cash": 5, "minimum": 3.11, "maximum": 109.864, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 68.67, "10th_percentile": 20.06, "90th_percentile": 68.67, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 32.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 32.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.14 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 20.13, "10th_percentile": 5.18, "90th_percentile": 20.13, "count": "15" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE - SOI : 1", "code_information": [ { "code": "7101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12552.54, "maximum": 13807.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13807.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13807.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 13807.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 12552.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12552.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12552.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12552.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12929.11, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12552.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Trypsin Feces Qual", "code_information": [ { "code": "84488", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103, "discounted_cash": 7, "minimum": 4.38, "maximum": 82.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 5.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25970, "minimum": 11265.79, "maximum": 47005.7181, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 47005.72, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 47005.72, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 21296.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 21296.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 33554.75 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 22148.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 44149.02, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 44149.02, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 27268.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 33761.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 41552.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 42986 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 21296.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 11265.79 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 21296.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 25970.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33009.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25970.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37880.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 21296.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32669.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21296.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28755.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 34838.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 29581.27 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 35059.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21935.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 21296.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR SMALL BOWEL PROCEDURES - SOI : 1", "code_information": [ { "code": "2301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16598.83, "maximum": 18258.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18258.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18258.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 18258.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 16598.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16598.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16598.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16598.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17096.8, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 16598.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "KIDNEY & URINARY TRACT MALIGNANCY - SOI : 3", "code_information": [ { "code": "4613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13795.2, "maximum": 15174.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15174.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15174.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 15174.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 13795.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13795.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13795.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13795.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14209.06, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 13795.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Heinz Bodies Induced Acetyl Phenylhydrazine", "code_information": [ { "code": "85445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.25, "discounted_cash": 6, "minimum": 4.09, "maximum": 71.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 21.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 5.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.82 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 6.82 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.46 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Storage/Year Sperm/Semen", "code_information": [ { "code": "89343", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511, "discounted_cash": 197, "minimum": 68.1163, "maximum": 418.8696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.78, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 207.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 276.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 316.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 266.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 1", "code_information": [ { "code": "0921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16218.58, "maximum": 17840.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17840.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17840.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 17840.44, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 16218.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16218.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16218.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16218.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16705.14, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 16218.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Arthrogram Of Wrist", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3147.76, "discounted_cash": 404, "minimum": 323.664, "maximum": 2518.208, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 857.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 857.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 646.62, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 809.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 809.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 424.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 566.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 647.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 546.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Orbits", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 789.11, "discounted_cash": 121, "minimum": 75.764, "maximum": 631.288, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 75.76 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 115.68, "10th_percentile": 115.68, "90th_percentile": 115.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hepatitis B Surface Ab Test", "code_information": [ { "code": "86706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159, "discounted_cash": 10, "minimum": 6.44, "maximum": 127.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 79.5, "10th_percentile": 79.5, "90th_percentile": 79.5, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 37.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 37.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 21.19, "10th_percentile": 21.19, "90th_percentile": 23.31, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenothiazine - G0480 - 30100385", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 918, "discounted_cash": 114, "minimum": 4.5255, "maximum": 734.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 216.19, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 216.19, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.19, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% 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": 2720, "discounted_cash": 154, "minimum": 123.432, "maximum": 2176, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.59, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 246.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180, "discounted_cash": 12, "minimum": 7.66, "maximum": 144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 27.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 25.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 25.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 15.31 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 42.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 42.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 10.21, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.76 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.21 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Face <2.5 Cm", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1784.57, "discounted_cash": 471, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 999.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 999.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 753.46, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 490.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 942.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 942.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 495, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 660, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 754.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 377.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1784.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1784.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1784.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1784.57 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 636.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Pm Pulse Gen Only (Existing Leads)", "code_information": [ { "code": "33221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83834.3, "discounted_cash": 22337, "minimum": 21.83, "maximum": 67067.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47355.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 47355.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35701.02, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23231.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 44675.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 44675.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 23454.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31272.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 35740.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 45702.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45702.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 45702.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34623.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17870.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8705 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7645 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 9284 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 7882 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30155.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23007.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Heart Image, Spect", "code_information": [ { "code": "78494", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 463, "minimum": 310.7969, "maximum": 1865.248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 459.42 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 482.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 486.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 649.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 718.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 370.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 625.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Foot 3+ Vw", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 756.5, "discounted_cash": 100, "minimum": 46.748, "maximum": 605.2, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 110.9, "10th_percentile": 100.84, "90th_percentile": 110.9, "count": "82" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 136.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 110.9, "10th_percentile": 100.84, "90th_percentile": 110.9, "count": "23" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.75 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.28, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 105.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 141.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 161.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 117.48, "10th_percentile": 117.48, "90th_percentile": 117.48, "count": "230" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 226.95, "10th_percentile": 226.95, "90th_percentile": 1382.1, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17838, "minimum": 7806.21, "maximum": 32287.0696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32287.07, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 32287.07, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 21539.21 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15431.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 30324.87, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 30324.87, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 18730.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23189.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 28541.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 26947 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 7806.21 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17838.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22999.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17838.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16293.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20970.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18458.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 22363.14 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 18988.58 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24081.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15283.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR O.R. PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS - SOI : 1", "code_information": [ { "code": "6801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19557.15, "maximum": 21512.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21512.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21512.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 21512.86, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 19557.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20143.86, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 19557.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "903", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16669, "minimum": 7265.62, "maximum": 30172.5552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30172.56, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 30172.56, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13910.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13910.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19813.02 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14466.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 28338.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 28338.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 17503.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21670.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 26671.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 27071 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13910.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 7265.62 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 13910.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16669.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21560.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16669.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16718.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13910.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19290.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13910.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16979.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 20570.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 17466.81 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22504.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14327.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13910.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 2", "code_information": [ { "code": "4692", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7578.23, "maximum": 8336.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8336.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8336.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 8336.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 7578.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7578.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7578.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7578.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7805.58, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7578.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Vital Capacity, Total", "code_information": [ { "code": "94150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216, "discounted_cash": 149, "minimum": 28.7928, "maximum": 216, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.19, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 208.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 119.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 216 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 216 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 216 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 216 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [ { "code": "552", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14281, "minimum": 5624.47, "maximum": 25850.1304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25850.13, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 25850.13, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12013.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12013.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16284.42 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 12494.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 24279.13, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 24279.13, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 14995.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18566.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 22850.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 21070 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12013.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 5624.47 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 12013.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14281.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18621.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14281.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10241.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12013.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15854.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12013.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13955.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 16907.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 14356.05 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19280.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12374.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12013.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tte 2D W Or W/O Fol W/Con Limited - 93308 - 48300015", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2132.6, "discounted_cash": 276, "minimum": 146.1861, "maximum": 1939, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 170.31, "10th_percentile": 170.31, "90th_percentile": 271.19, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1817 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1599 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1939 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1649 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 271.19, "10th_percentile": 271.19, "90th_percentile": 271.19, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER GASTROENTERITIS, NAUSEA & VOMITING - SOI : 3", "code_information": [ { "code": "2493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10228.45, "maximum": 11251.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11251.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11251.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 11251.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 10228.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10228.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10228.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10228.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10535.3, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10228.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Myelin Basic Protein,Csf", "code_information": [ { "code": "83873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334, "discounted_cash": 17, "minimum": 10.32, "maximum": 267.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 36.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 20.64 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 78.66, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 78.66, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.66, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 2", "code_information": [ { "code": "0092", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 52534.38, "maximum": 57787.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 57787.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 57787.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 57787.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 52534.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 52534.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 52534.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 52534.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 54110.41, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 52534.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ehrlichia, Antibody", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668, "discounted_cash": 10, "minimum": 6.11, "maximum": 534.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.58, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 21.58, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 157.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 157.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 10.18 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Revasc Tibial/Peron Art Angiopl/Stnt/Atherc Ini", "code_information": [ { "code": "37231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73910.7, "discounted_cash": 20382, "minimum": 21.83, "maximum": 59128.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43211.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 43211.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20382.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20382.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32576.7, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21198.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 40765.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 40765.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 21402, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28536, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 32612.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 41703.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 41703.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 41703.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20382.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 20382.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20382.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31593.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 20382.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20382.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16306.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20382.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 10054 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 8540 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27516.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20994.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20382.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-2", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285, "discounted_cash": 20, "minimum": 12.14, "maximum": 228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 42.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.35, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 40.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 40.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 24.29 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 67.12, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 67.12, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.12, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.14 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 20.24 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.19 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Cath Subselect Art,Abd/Pel", "code_information": [ { "code": "36246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6503, "minimum": 21.83, "maximum": 15580.8, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 } ] } ] }, { "description": "Tis Trnfr S/A/L 10 Sq Cm/<", "code_information": [ { "code": "14020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2392, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3230.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2464.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5072.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5072.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3824.24, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2488.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4785.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4785.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2512.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3349.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3828.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4895.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4895.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4895.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3708.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1914.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 } ] } ] }, { "description": "Hc Blood Typing Antigen System", "code_information": [ { "code": "86911", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.08, "minimum": 5, "maximum": 181.664, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "description": "Hc Rbc, Frz/Deg/Wsh, L/R, Irrad Per Unit", "code_information": [ { "code": "P9057", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1037.25, "discounted_cash": 420, "minimum": 138.2654, "maximum": 891.7144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 891.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 891.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 672.25, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 437.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 841.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 841.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 441.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 588.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 672.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 860.59, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 860.59, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 860.59, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 651.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 336.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 567.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 433.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [ { "code": "041", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28468, "minimum": 14722.25, "maximum": 51527.3515, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 51527.35, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 51527.35, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23280.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 23280.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 37245.98 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 24211.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 48395.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 48395.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 29891.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 37008.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 45549.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 48640 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 23280.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 14722.25 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 23280.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 28468.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36084.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28468.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33436.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 23280.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36263.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23280.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31918.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 38670.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 32835.39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 38432, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23978.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 23280.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Speech Threshold Audiometry", "code_information": [ { "code": "92555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 68, "minimum": 20.3349, "maximum": 152.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 145.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.32, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 136.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 136.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 71.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 109.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 92.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Lumbar Spine 2/3 Vw", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 789.11, "discounted_cash": 121, "minimum": 59.644, "maximum": 631.288, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.64 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 122.55, "10th_percentile": 122.55, "90th_percentile": 122.55, "count": "71" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 115.68, "10th_percentile": 105.19, "90th_percentile": 115.68, "count": "38" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 115.68, "10th_percentile": 115.68, "90th_percentile": 115.68, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS - SOI : 3", "code_information": [ { "code": "4253", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9403.46, "maximum": 10343.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10343.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10343.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 10343.81, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 9403.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9403.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9403.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9403.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9685.57, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9403.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Hand Tum Deep 1.5 Cm/>", "code_information": [ { "code": "26113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 1915, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 597.52, "10th_percentile": 597.52, "90th_percentile": 597.52, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ex For Speech Device Rx Ea Add 30 Min", "code_information": [ { "code": "92608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219, "discounted_cash": 53, "minimum": 29.1927, "maximum": 219, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 112.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.37, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.27, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 106.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 106.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 55.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 74.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 51.57, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 51.57, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.57, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 219 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 219 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 219 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 219 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY & URINARY TRACT INFECTIONS - SOI : 1", "code_information": [ { "code": "4631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5996.54, "maximum": 6596.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6596.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6596.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 6596.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 5996.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5996.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5996.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5996.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6176.44, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5996.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM - SOI : 3", "code_information": [ { "code": "0583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17007.49, "maximum": 18708.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18708.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18708.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 18708.23, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 17007.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17007.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17007.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17007.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17517.71, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17007.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ro Radn Treatment Aid(S) Complx", "code_information": [ { "code": "77334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2180.99, "discounted_cash": 434, "minimum": 290.726, "maximum": 1744.792, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 920.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 920.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 434.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 434.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 693.99, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 451.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 868.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 868.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 455.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 607.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 694.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 888.41, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 888.41, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 888.41, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 434.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 677.42, "10th_percentile": 338.71, "90th_percentile": 1016.12, "count": "15" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 434.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 434.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 673.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 434.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 434.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 347.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1453 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 434.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1275 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1550 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1315 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 959.2, "10th_percentile": 319.73, "90th_percentile": 1598.67, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 586.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 447.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 959.2, "10th_percentile": 959.2, "90th_percentile": 959.2, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 434.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell C1782) Morcellator", "code_information": [ { "code": "C1782", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 989.26, "10th_percentile": 989.26, "90th_percentile": 989.26, "count": "1 through 10" } ] } ] }, { "description": "Hc Echo Heart Xthoracic,Complete, W/O Doppler", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2325, "discounted_cash": 276, "minimum": 221.36, "maximum": 2627.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1817 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1599 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1939 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1649 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4556) Electrodes, Pair", "code_information": [ { "code": "A4556", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 27.9, "10th_percentile": 27.9, "90th_percentile": 58.02, "count": "1 through 10" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 23.95, "10th_percentile": 23.95, "90th_percentile": 26.34, "count": "1 through 10" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "145", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17044, "minimum": 6640.45, "maximum": 30851.1061, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30851.11, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 30851.11, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20366.96 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14776.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 28976.18, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 28976.18, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 17897.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22158.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 27271.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 26626 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 14208.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17044.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22022.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17044.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6640.45 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19829.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14208.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17453.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 21146.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 17955.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23010.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14634.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14208.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat A-C Jt Disloc Wo Manip", "code_information": [ { "code": "23540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1519, "discounted_cash": 286, "minimum": 202.4827, "maximum": 1519, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1519 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1519 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1519 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1519 } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 2", "code_information": [ { "code": "9102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34837.35, "maximum": 38321.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38321.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 38321.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 38321.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 34837.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 34837.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 34837.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 34837.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 35882.47, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 34837.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21950, "minimum": 10226.42, "maximum": 39730.4412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39730.44, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 39730.44, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 27615.59 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 18828.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 37315.88, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 37315.88, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 23048.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28535.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 35120.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 36388 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 18104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10226.42 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 18104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 21950.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28061.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21950.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21870.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26886.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18104.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23665.61 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 28671.96 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 24345.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29633.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18647.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18104.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pelvis", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 6453, "minimum": 1750.1757, "maximum": 13129.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13129.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 13129.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10313.62, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6711.23, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 12906.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 12906.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 6775.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9034.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 10324.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 13129.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 13129.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 13129.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10002.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5162.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7155.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7155.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4770.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4770.37 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8711.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6646.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR PANCREAS, LIVER & SHUNT PROCEDURES - SOI : 2", "code_information": [ { "code": "2602", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28193.69, "maximum": 31013.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 31013.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31013.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 31013.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 28193.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28193.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 28193.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28193.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 29039.5, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 28193.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Punch Biopsy Skin Single Lesion", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.25, "discounted_cash": 471, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 882.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 882.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 753.46, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 490.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 882.25, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 882.25, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 495, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 660, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 754.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 882.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 882.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 882.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 377.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 882.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 882.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 882.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 882.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 636.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Inten Mod Radiother Plan W/Dose Vol Hist", "code_information": [ { "code": "77301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6201.37, "discounted_cash": 1605, "minimum": 826.6426, "maximum": 4961.096, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3402.96, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3402.96, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2565.45, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1669.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3210.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3210.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1685.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2247.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2568.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3284.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3284.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3284.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 925.28, "10th_percentile": 925.28, "90th_percentile": 925.28, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2488.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1284.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1453 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1275 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1550 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1315 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 873.44, "10th_percentile": 873.44, "90th_percentile": 909.12, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2166.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1653.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 873.44, "10th_percentile": 873.44, "90th_percentile": 873.44, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SIGNIFICANT TRAUMA WO O.R. PROCEDURE - SOI : 3", "code_information": [ { "code": "9303", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18251.34, "maximum": 20076.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20076.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20076.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 20076.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 18251.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18251.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18251.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18251.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18798.88, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18251.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BWT 1250-1499G W OR WO OTHER SIGNIFICANT CONDITION - SOI : 2", "code_information": [ { "code": "6082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 47253.25, "maximum": 51978.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 51978.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 51978.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 51978.57, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 47253.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 47253.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 47253.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 47253.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 48670.85, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 47253.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION - SOI : 3", "code_information": [ { "code": "6393", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19243.91, "maximum": 21168.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21168.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21168.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 21168.3, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 19243.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19243.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19243.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19243.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19821.23, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 19243.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Methadone - 80358 - 30100205", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.98, "minimum": 16.48, "maximum": 159.984, "payers_information": [ { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.48 } ] } ] }, { "description": "Hc Metabolic Panel,Comprehensive", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370, "discounted_cash": 10, "minimum": 6.34, "maximum": 296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 185, "10th_percentile": 185, "90th_percentile": 185, "count": "73" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 21.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 21.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 87.14, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 87.14, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.14, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 341.44, "10th_percentile": 206.85, "90th_percentile": 673.5, "count": "16" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 54.24, "10th_percentile": 49.32, "90th_percentile": 54.24, "count": "101" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL MENINGITIS - SOI : 3", "code_information": [ { "code": "0513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15344.61, "maximum": 16879.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16879.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16879.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 16879.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 15344.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15344.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15344.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15344.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15804.95, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 15344.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Colorectal Cancer Screen, Sigmoid, Ba Enema - G0106 - 32000239", "code_information": [ { "code": "G0106", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1581.37, "discounted_cash": 198, "minimum": 158.968, "maximum": 1265.096, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 421.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 421.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 317.59, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 397.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 397.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 208.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 278.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 317.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 406.56, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 406.56, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 406.56, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 198.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 198.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 198.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.97, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 198.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 204.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remv Perm Pacer Generator", "code_information": [ { "code": "33233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25035.3, "discounted_cash": 9596, "minimum": 21.83, "maximum": 20345.4916, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20345.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20345.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15338.2, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9980.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 19193.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 19193.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 10076.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13435.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 15355.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 19635.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 19635.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 19635.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14875.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7677.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12955.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9884.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9596.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Hdr Ntrstl/Intrcav Brachyther 1 Chan", "code_information": [ { "code": "77770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5170.41, "discounted_cash": 807, "minimum": 646.152, "maximum": 4136.328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1712.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1712.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 807.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 807.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1290.88, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 840, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1615.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1615.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 848.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1130.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1292.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1652.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1652.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1652.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 807.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 807.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 807.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1251.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 807.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 807.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 646.15, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1453 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 807.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1275 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1550 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1315 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1090.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 831.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 807.69, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 4", "code_information": [ { "code": "5314", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21320.58, "maximum": 23452.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23452.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23452.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 23452.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 21320.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21320.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21320.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21320.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21960.19, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21320.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Heparin Neutralization", "code_information": [ { "code": "85525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 11, "minimum": 7.1, "maximum": 111.144, "payers_information": [ { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 23.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 23.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.84 } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20511, "minimum": 10222.68, "maximum": 37126.1951, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37126.2, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 37126.2, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16961.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16961.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25489.62 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17639.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34869.91, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 34869.91, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 21537.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26665.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 32818.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 33593 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16961.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10222.68 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 16961.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20511.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26290.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20511.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18411.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16961.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24817.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16961.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21843.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26464.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22471.19 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27690.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17470.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16961.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [ { "code": "371", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23588, "minimum": 10854.42, "maximum": 42695.7461, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 42695.75, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 42695.75, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19405.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19405.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 30036.31 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 20181.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 40100.98, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 40100.98, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 24768.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30665.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 37742.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 38109 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19405.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10854.42 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 19405.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 23588.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30078.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23588.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21365.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19405.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29243.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19405.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25740.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 31185.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26479.48 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31844.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19987.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19405.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Sesamoid Fx", "code_information": [ { "code": "28530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 286, "minimum": 133.1867, "maximum": 999.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Toe Fx W Manip Ea", "code_information": [ { "code": "28515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 286, "minimum": 133.1867, "maximum": 999.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Withdrawal Of Arterial Blood", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.7, "discounted_cash": 154, "minimum": 76.2076, "maximum": 571.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.59, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 246.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 88.79, "10th_percentile": 76.25, "90th_percentile": 177.57, "count": "18" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 83.81, "10th_percentile": 71.98, "90th_percentile": 143.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Body Fluid Cell Count W Diff", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.33, "discounted_cash": 5, "minimum": 3.36, "maximum": 174.664, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6.72 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.48 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inject Nerv Blck,Paravert Sympath", "code_information": [ { "code": "64520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3194.65, "discounted_cash": 1025, "minimum": 425.8468, "maximum": 3194.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2174.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2174.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1639.35, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1066.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2051.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2051.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1077.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1436.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1641.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1589.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 820.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3194.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1384.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1056.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Duplex Large Vessel(S),Complete", "code_information": [ { "code": "93978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1451, "discounted_cash": 276, "minimum": 193.4183, "maximum": 1451, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 225.34, "10th_percentile": 225.34, "90th_percentile": 225.34, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1451 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1275 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1451 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1259 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 271.19, "10th_percentile": 271.19, "90th_percentile": 271.19, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 1", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9770.82, "maximum": 10747.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10747.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10747.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 10747.9, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 9770.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9770.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9770.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9770.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10063.95, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9770.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITH CCMCC", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24026, "minimum": 10614.7, "maximum": 43488.4356, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43488.44, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 43488.44, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19753.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19753.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 30683.42 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 20543.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 40845.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 40845.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 25228.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31234.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 38442.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 42400 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19753.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10614.7 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 19753.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 24026.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30617.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24026.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21001.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19753.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29873.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19753.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26294.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 31857.14 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 27049.95 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32436.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20345.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19753.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Whole Blood, Leuko Reduced, Irradiated, Ea Unit", "code_information": [ { "code": "P9056", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 621.85, "discounted_cash": 84, "minimum": 67.312, "maximum": 497.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 178.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.48, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 88.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 117.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 172.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 172.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 172.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE - SOI : 2", "code_information": [ { "code": "2522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8690.66, "maximum": 9559.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9559.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9559.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 9559.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 8690.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8690.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8690.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8690.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8951.38, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8690.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "REPAIR BLADDER DEFECT", "code_information": [ { "code": "57288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13143.75, "discounted_cash": 5801, "minimum": 21.83, "maximum": 12298.7772, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5729 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6954 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5907 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7831.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5975.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12298.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 12298.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9271.89, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6033.36, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 11602.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 11602.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 6091.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8121.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 9282.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11869.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11869.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11869.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8992.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4641.05, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6521 } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 3", "code_information": [ { "code": "1773", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29387.3, "maximum": 32326.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32326.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32326.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 32326.03, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 29387.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29387.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29387.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29387.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 30268.92, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 29387.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ct Heart W/O Contrast Quant Eval Coronary Calcium", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.02, "discounted_cash": 100, "minimum": 55.8554, "maximum": 419.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 419.02 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.28, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 105.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 141.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 161.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 125.71, "10th_percentile": 125.71, "90th_percentile": 125.71, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 136.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Elect Stimul Unattnd For Ulcers - G0281 - 42000026", "code_information": [ { "code": "G0281", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245, "discounted_cash": 12, "minimum": 10.36, "maximum": 245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 25.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 25.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 15.54, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 245 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 245 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 245 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 245 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Pms2 Gene Analysis Full Sequence", "code_information": [ { "code": "81317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1500, "discounted_cash": 676, "minimum": 199.95, "maximum": 1434.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1434.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1434.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 980.93, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 703.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1353, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1353, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 710.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 947.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 811.8, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 353.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 353.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 353.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1048.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 541.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 405.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 405.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 676.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 676.5 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 541.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 913.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 696.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 676.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 254, "discounted_cash": 14, "minimum": 8.75, "maximum": 203.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 30.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 29.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 29.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 59.82, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 59.82, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.82, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 11.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.59 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.67 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Work Hardening Ea Add Hr", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173, "minimum": 23.0609, "maximum": 173, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158 }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 173 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 173 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 173 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 173 } ] } ] }, { "description": "Hc Repr Wnd Cplx Trnk Add 5.0 Cm", "code_information": [ { "code": "13102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 851.38, "minimum": 21.83, "maximum": 851.38, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 851.38 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 851.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 851.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 851.38 } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES - SOI : 2", "code_information": [ { "code": "3642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12994.74, "maximum": 14294.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14294.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14294.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 14294.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 12994.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12994.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12994.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12994.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13384.58, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12994.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cytopath, Cell Enhance Tech", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 740, "discounted_cash": 60, "minimum": 29.68, "maximum": 592, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 128.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 176.34, "10th_percentile": 176.34, "90th_percentile": 176.34, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.58, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 120.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 120.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 84.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 96.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.24 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 49.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 49.47 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.24 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Vma", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218, "discounted_cash": 15, "minimum": 9.3, "maximum": 174.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 32.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 18.6 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 51.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 51.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drainage Of Palmar Bursa Single Bursa", "code_information": [ { "code": "26025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6749.7, "discounted_cash": 3794, "minimum": 21.83, "maximum": 6749.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6064.57, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3984.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5312.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6071.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6749.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5881.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3035.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5122.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3908.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Sinuses <3 Vw", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.02, "discounted_cash": 100, "minimum": 51.584, "maximum": 335.216, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.58 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.28, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 105.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 141.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 161.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 136.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [ { "code": "480", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36649, "minimum": 18917.2, "maximum": 66335.2149, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 66335.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 66335.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29777.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 29777.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 49334.36 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 30969.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 62303.79, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 62303.79, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 38481.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 47644.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 58638.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 64301 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 29777.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 18917.2 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 29777.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 36649.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46155.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36649.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56704.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 29777.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48032.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29777.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42277.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 51221.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 43492.29 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49476.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30671.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 29777.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drain Lower Leg Deep Absc/Hematoma", "code_information": [ { "code": "27603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3368, "minimum": 21.83, "maximum": 8595.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5383.8, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3537.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4716.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5389.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5221.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2694.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4547.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3469.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Flowcytometry/ Tech Component, 1 Marker", "code_information": [ { "code": "88184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1608.72, "discounted_cash": 415, "minimum": 64.38, "maximum": 1286.976, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 664.36, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 831.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 831.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 436.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 581.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 665.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.38 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 332.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.38 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 881.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 881.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Vasopressin Iv Soln 20 Unit/Ml (For Iv Infusion)", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "42023016401", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES - SOI : 4", "code_information": [ { "code": "0984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46533.97, "maximum": 51187.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 51187.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 51187.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 51187.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 46533.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 46533.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 46533.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 46533.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 47929.99, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 46533.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Rbc Leukocytes Reduced, Per Unit", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 741.36, "discounted_cash": 184, "minimum": 98.8233, "maximum": 593.088, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 390.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 390.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 294.08, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 191.36, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 368, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 368, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 193.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 257.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 294.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 376.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 376.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 376.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 147.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 108.68, "10th_percentile": 101.03, "90th_percentile": 202.05, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 248.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 189.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 184, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hemoglobin Electrophoresis", "code_information": [ { "code": "83020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213, "discounted_cash": 12, "minimum": 7.72, "maximum": 170.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 27.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 106.5, "10th_percentile": 106.5, "90th_percentile": 106.5, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 50.16, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 50.16, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.16, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.87 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Kit Gene Analysis Targeted Sequence Analysis", "code_information": [ { "code": "81272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 962.28, "discounted_cash": 329, "minimum": 128.2719, "maximum": 769.824, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 698.56, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 698.56, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 477.79, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 342.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 659.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 659.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 345.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 461.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 395.41, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 226.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 226.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 226.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 510.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 329.51 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 329.51 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 444.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 339.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 747, "discounted_cash": 14, "minimum": 8.94, "maximum": 597.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 31.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.61, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 175.92, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 175.92, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.92, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 11.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.9 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prep Wnd Trk/Ar/Lg 100 Sqcm Or 1% Peds", "code_information": [ { "code": "15002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2402.4, "discounted_cash": 857, "minimum": 21.83, "maximum": 2402.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1817.03, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1817.03, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1369.84, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 891.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1714.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1714.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 899.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1199.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1371.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1753.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1753.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1753.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1328.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 685.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2402.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2402.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2402.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2402.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1157.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 882.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE - SOI : 3", "code_information": [ { "code": "6313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 69978.85, "maximum": 76976.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 76976.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 76976.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 76976.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 69978.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 69978.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 69978.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 69978.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 72078.22, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 69978.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Translum Peripheral Atherectomy Renal Art", "code_information": [ { "code": "0234T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48762.2, "discounted_cash": 13387, "minimum": 21.83, "maximum": 39009.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28382.03, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28382.03, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21396.84, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13923.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 26775.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 26775.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 14057.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18742.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 21420.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 27391.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 27391.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 27391.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20751.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10710.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8705 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7645 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 9284 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 7882 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18073.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13789.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Transcath Stent Cca W/O Eps", "code_information": [ { "code": "37216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1000, "minimum": 21.83, "maximum": 1000, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1000 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1000 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1000 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1000 } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES - SOI : 3", "code_information": [ { "code": "0223", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27253.98, "maximum": 29979.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 29979.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 29979.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 29979.37, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 27253.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27253.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27253.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27253.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 28071.6, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 27253.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Foot/Toe Tum Sc 1.5 Cm/>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 3368, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5383.8, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3537.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4716.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5389.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 2390.07, "10th_percentile": 2390.07, "90th_percentile": 2390.07, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5221.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2694.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4547.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3469.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23485, "minimum": 11129.08, "maximum": 42508.9903, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 42508.99, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 42508.99, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19323.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19323.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29883.85 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 20096.23, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 39925.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 39925.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 24659.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30531.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 37577.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 38684 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19323.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 11129.08 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 19323.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 23485.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29951.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23485.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11201.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19323.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29095.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19323.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25609.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 31026.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26345.07 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31705.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19903, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19323.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Program Eval Implantable In Prsn 1 Ld Pacemaker", "code_information": [ { "code": "93279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.1, "discounted_cash": 43, "minimum": 22.4077, "maximum": 168.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 91.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.17, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 86.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 86.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 45.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 60.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 69.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 88.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 88.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 168.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 168.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 168.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 168.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.28, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "675", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22078, "minimum": 10145.89, "maximum": 39962.8452, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 39962.85, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 39962.85, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 27805.32 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 18934.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 37534.16, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 37534.16, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 23182.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28702.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 35326.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 34594 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 18206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10145.89 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 18206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 22078.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28219.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22078.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29483.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27071.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23828.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 28868.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 24512.67 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 29806.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18752.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18206.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc Skin Malig 2.1-3 Cm Scalp/Neck/Hnd/Ft/Gent", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1915, "minimum": 21.83, "maximum": 4946.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3622 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3861 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3280 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6951", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7525.38, "maximum": 8277.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8277.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8277.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 8277.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 7525.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7525.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7525.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7525.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7751.14, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7525.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Blood Typing, Patient Serum", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106, "discounted_cash": 68, "minimum": 9.8, "maximum": 106, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 106, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 106, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 106, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 71.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 106, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 106, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 106, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 106, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 16.34 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.7 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 92.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fecal Microbiota Prep And Instillation - G0455 - 75000127", "code_information": [ { "code": "G0455", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4090.41, "discounted_cash": 1078, "minimum": 21.83, "maximum": 3272.328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2286.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2286.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1723.64, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1121.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2156.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2156.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1132.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1509.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1725.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2206.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2206.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2206.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1671.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 862.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1455.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1110.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cytopath C/V Index Add-On", "code_information": [ { "code": "88155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.95, "discounted_cash": 14, "minimum": 8.79, "maximum": 84.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 17.58 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.65 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Specimen Concentrat, Infect Agents", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95, "discounted_cash": 6, "minimum": 4.01, "maximum": 76, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 8.02 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.34 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hepatitis B Surface Ag, Eia", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145, "discounted_cash": 10, "minimum": 6.2, "maximum": 116, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 72.5, "10th_percentile": 72.5, "90th_percentile": 72.5, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 20.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 20.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "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": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 19.33, "10th_percentile": 10.33, "90th_percentile": 21.26, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Revasc Intra Lithotrip-Ather", "code_information": [ { "code": "C9766", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82011.6, "discounted_cash": 21259, "minimum": 21.83, "maximum": 65609.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45069.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 45069.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21259.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21259.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33977.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22109.5, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 42518.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 42518.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 22322.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29762.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 34014.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 43496.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 43496.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 43496.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21259.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 21259.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21259.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32951.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 21259.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21259.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17007.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8705 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21259.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7645 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 9284 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 7882 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28699.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21896.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21259.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "042", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23068, "minimum": 11682.79, "maximum": 41753.6592, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 41753.66, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 41753.66, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29267.24 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19751.58, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 39216.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 39216.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 24221.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29988.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 36909.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 37936 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 18991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 11682.79 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 18991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 23068.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29437.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23068.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22717.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28494.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18991.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25081.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 30386.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 25801.47 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31142.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19561.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18991.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CCMCC", "code_information": [ { "code": "829", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39489, "minimum": 19412.22, "maximum": 71475.2348, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 71475.23, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 71475.23, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 32033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 53530.4 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 33314.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 67131.44, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 67131.44, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 41463.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 51335.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 63182.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 68769 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 32033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 19412.22 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 32033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 39489.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49651.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39489.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39675.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 32033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52117.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32033.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45873.72 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 55578.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 47191.44 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 53310.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32994.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 32033.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc St Behavi Qualt Analysis Voice & Resonance, 60 Min", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1618, "discounted_cash": 120, "minimum": 53.9198, "maximum": 1294.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.03, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 256.03, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 241.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 241.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 126.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 144.92, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 381.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 381.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 381.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 120.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 120.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 120.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 120.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.77, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VERTIGO & OTHER LABYRINTH DISORDERS - SOI : 1", "code_information": [ { "code": "1111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6949.15, "maximum": 7644.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7644.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7644.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 7644.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 6949.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6949.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6949.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6949.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7157.62, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6949.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 3", "code_information": [ { "code": "2013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10972.26, "maximum": 12069.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12069.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12069.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 12069.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 10972.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10972.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10972.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10972.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11301.43, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10972.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Remv F.B.,Eye,Cornea,No Slit", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1783.21, "discounted_cash": 518, "minimum": 21.83, "maximum": 1783.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1098.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1098.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 518.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 518.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 827.98, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 538.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1036.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1036.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 543.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 725.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 828.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1059.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1059.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1059.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 518.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 518.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 518.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 802.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 518.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 518.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 414.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1783.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 518.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1783.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1783.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1783.21 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 699.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 533.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 518.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS - SOI : 3", "code_information": [ { "code": "5323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10010.63, "maximum": 11011.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11011.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11011.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 11011.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 10010.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10010.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10010.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10010.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10310.95, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10010.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ugt1A1 Gene Analysis Common Variants", "code_information": [ { "code": "81350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 906, "discounted_cash": 234, "minimum": 120.7698, "maximum": 724.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 496.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 496.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 339.3, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.36, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 468, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 468, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 245.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 327.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 280.8, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 213.36, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 213.36, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.36, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 362.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 140.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 234 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 234 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.9, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Massage Therapy Ea 15 Min", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 651, "discounted_cash": 33, "minimum": 26.656, "maximum": 520.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 70.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 66.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 66.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 34.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 46.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 39.98, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 153.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 153.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Escharotomy", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1463.1, "discounted_cash": 471, "minimum": 21.83, "maximum": 1463.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 999.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 999.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 753.46, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 490.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 942.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 942.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 495, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 660, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 754.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 377.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1463.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1463.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1463.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1463.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 636.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drainage Of Pelvic Abscess", "code_information": [ { "code": "57010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10427.4, "discounted_cash": 3754, "minimum": 21.83, "maximum": 8341.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7958.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7958.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3754.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3754.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5999.9, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3904.23, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7508.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7508.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3941.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5255.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6006.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7680.83, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7680.83, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7680.83, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3754.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3754.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3754.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5818.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3754.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3754.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3003.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3754.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5067.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3866.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3754.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ephys Eval W Ablation Supravent Arrhythmia", "code_information": [ { "code": "93653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106296, "discounted_cash": 30311, "minimum": 21.83, "maximum": 85036.8, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 62018.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 62018.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 62018.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30311.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 16507.74, "10th_percentile": 16507.74, "90th_percentile": 16507.74, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 30311.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 30311.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46983.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 30311.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30311.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24249.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10159 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30311.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8927 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 10835 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 9204 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40921.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31221.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 15582.97, "10th_percentile": 15582.97, "90th_percentile": 15582.97, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30311.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64261.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 64261.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30311.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30311.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48445.82, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31524.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 60623.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 60623.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 31827.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 42436.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 48499.17, "additional_payer_notes": "160.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nutr Ther, Subsq W Dx Change, Indiv, Ea 15 Min - G0270 - 94200011", "code_information": [ { "code": "G0270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 24, "minimum": 19.264, "maximum": 200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 51.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.32, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 48.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 48.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 28.9, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 47.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 200 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 200 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Insert Tunnel Intraperitoneal Cath W Img Guide", "code_information": [ { "code": "49418", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15483.9, "discounted_cash": 4152, "minimum": 2064.0039, "maximum": 12387.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8802.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8802.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6636.16, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4318.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8304.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 8304.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4359.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5813.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6643.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8495.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8495.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8495.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6435.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3321.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5605.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4276.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Single Transven Electrod/Pm/Defib", "code_information": [ { "code": "33218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17575.4, "discounted_cash": 4333, "minimum": 21.83, "maximum": 14060.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9187.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9187.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4333.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4333.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6926.34, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4507.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8667.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 8667.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4550.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6067.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6933.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8866.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8866.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8866.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4333.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4333.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4333.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6717.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4333.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4333.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3466.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4333.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5850.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4463.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4333.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hospital Outpt Clinic Visit Lvl Iv", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.7, "discounted_cash": 154, "minimum": 41.8562, "maximum": 790.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 327.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 308.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 87.52, "10th_percentile": 87.52, "90th_percentile": 100.13, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 100.13, "10th_percentile": 79.58, "90th_percentile": 121.82, "count": "146" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 4", "code_information": [ { "code": "1924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37711.88, "maximum": 41483.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 41483.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 41483.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 41483.06, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 37711.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 37711.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 37711.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 37711.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 38843.23, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 37711.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Legion Pneumo Ag, Dfa", "code_information": [ { "code": "87278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95, "discounted_cash": 15, "minimum": 9.36, "maximum": 76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 33.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 31.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 18.72 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 15.6 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.48 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bamlanivimab And Etesevimab Infusion And Monitoring", "code_information": [ { "code": "M0245", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1548, "discounted_cash": 511, "minimum": 206.3484, "maximum": 1238.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1084.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1084.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 817.28, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 531.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1022.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1022.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 536.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 715.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 818.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1046.24, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1046.24, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.24, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 511.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 511.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 792.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 511.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 409.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 359 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 511.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 338 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 383 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 348 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 690.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 526.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES - SOI : 3", "code_information": [ { "code": "2073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11776.6, "maximum": 12954.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12954.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12954.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 12954.26, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 11776.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11776.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11776.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11776.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12129.9, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11776.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Heart Infarct Image", "code_information": [ { "code": "78466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 463, "minimum": 214.396, "maximum": 1865.248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 214.4 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 482.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 486.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 649.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 718.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 370.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 625.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Angio, Chest, Combo, Incl Image Proc", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3620, "discounted_cash": 203, "minimum": 162.728, "maximum": 2896, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 638.35 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 213.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 284.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 325.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 562.19, "10th_percentile": 562.19, "90th_percentile": 562.19, "count": "84" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 530.69, "10th_percentile": 482.55, "90th_percentile": 530.69, "count": "31" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 274.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 530.69, "10th_percentile": 482.55, "90th_percentile": 530.69, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Smear Micro Exam W/O Manual Diff", "code_information": [ { "code": "85008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48, "discounted_cash": 3, "minimum": 2.06, "maximum": 38.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 4.12 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.43 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.74 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Group Psychotherapy", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.3, "discounted_cash": 117, "minimum": 27.5, "maximum": 921.504, "payers_information": [ { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 159.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 168.87, "10th_percentile": 51.5, "90th_percentile": 168.87, "count": "36" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 249.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 249.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.14 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 235.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 235.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 123.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 164.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 188.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 241.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 241.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 241.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.25, "additional_payer_notes": "80.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A4450) Non-Waterproof Tape - A4450 - 27090028", "code_information": [ { "code": "A4450", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 1.86, "10th_percentile": 1.4, "90th_percentile": 4.5, "count": "1 through 10" } ] } ] }, { "description": "Treat Metacarpal Fracture - 26608 - OR36026608", "code_information": [ { "code": "26608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18165, "discounted_cash": 3794, "minimum": 21.83, "maximum": 14532, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8044.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8044.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6064.57, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3984.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5312.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6071.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5881.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3035.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5122.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3908.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Myelography Lumbar Inj, Cervical", "code_information": [ { "code": "62302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2307, "discounted_cash": 909, "minimum": 21.83, "maximum": 2307, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1927.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1927.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1452.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1818.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1818.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 954.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1272.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1454.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1409.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 727.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 936.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - G0480 - 30100071", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.68, "discounted_cash": 114, "minimum": 4.5255, "maximum": 734.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 211.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 119.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 211.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 211.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 49.85, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 49.85, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.85, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 91.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 114.43 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.54 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 114.43, "10th_percentile": 114.43, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Smp Body/Scalp/Extr >30.1 Cm", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2061, "discounted_cash": 232, "minimum": 21.83, "maximum": 2061, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 493.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 493.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 371.86, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 465.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 465.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 244.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 325.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 372.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 476.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 476.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 476.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 186.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2061 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2061 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2061 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2061 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 314.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nitroblue Tetrazolium Dye", "code_information": [ { "code": "86384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160, "discounted_cash": 13, "minimum": 8.17, "maximum": 128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 16.33 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 37.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 37.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 13.61 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.89 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - 27200146", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 2.5, "10th_percentile": 1.53, "90th_percentile": 5, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 0.78, "10th_percentile": 0.78, "90th_percentile": 2.33, "count": "102" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 0.73, "10th_percentile": 0.67, "90th_percentile": 1.69, "count": "37" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 0.73, "10th_percentile": 0.73, "90th_percentile": 1.12, "count": "1 through 10" } ] } ] }, { "description": "Hc Assay Of Total Testosterone", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 363, "discounted_cash": 25, "minimum": 15.49, "maximum": 290.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 54.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.42, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 51.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 51.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 30.97 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 85.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 85.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 53.22, "10th_percentile": 53.22, "90th_percentile": 53.22, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.81 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 25.81 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc (Sup Shell A6257) Transparent Film <= 16 Sq In - A6257 - RU272058", "code_information": [ { "code": "A6257", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 2.5, "10th_percentile": 1.53, "90th_percentile": 5, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 0.78, "10th_percentile": 0.78, "90th_percentile": 2.33, "count": "102" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 0.73, "10th_percentile": 0.67, "90th_percentile": 1.69, "count": "37" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 0.73, "10th_percentile": 0.73, "90th_percentile": 1.12, "count": "1 through 10" } ] } ] }, { "description": "DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER - SOI : 1", "code_information": [ { "code": "7541", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4005, "maximum": 4405.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 4405.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4405.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 4405.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 4005, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4005, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4005, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4005, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4125.15, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 4005, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - 75710 - 32300016", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4038.72, "discounted_cash": 3661, "minimum": 538.3614, "maximum": 13219.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 2215.46, "10th_percentile": 2215.46, "90th_percentile": 2215.46, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4038.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4038.72 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 3531.24, "10th_percentile": 3531.24, "90th_percentile": 3531.24, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4038.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Respiratory Virus", "code_information": [ { "code": "86756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181, "discounted_cash": 15, "minimum": 9.53, "maximum": 144.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 33.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 31.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 31.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 19.07 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 42.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 42.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "100.00% 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": 57050, "minimum": 27282.74, "maximum": 103364, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 103261.53, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 103261.53, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45980.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 45980.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 79479.09 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 47819.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 96985.97, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 96985.97, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 59903.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 74165.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 91280.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 103364 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 45980.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 27282.74 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 45980.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 57050.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 71269.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 57050.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 74988.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 45980.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 77381.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45980.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 68110.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 82519.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 70067.34 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 77018.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 47360.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 45980.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tramadol Assay, Definitive - 80373 - 30100419", "code_information": [ { "code": "80373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123, "minimum": 16.3959, "maximum": 98.4, "payers_information": [ { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.66 } ] } ] }, { "description": "OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES - SOI : 2", "code_information": [ { "code": "1672", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38344.76, "maximum": 42179.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 42179.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 42179.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 42179.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 38344.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 38344.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 38344.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 38344.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 39495.11, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 38344.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ileocopy Thru Stoma W Blln Dilate", "code_information": [ { "code": "44381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890, "discounted_cash": 2225, "minimum": 21.83, "maximum": 2890, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2292.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2314.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2336.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1780.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2890, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "Hc Supslctv Cath 2Nd+Ord Renl&Acces Artery/S&I Uni", "code_information": [ { "code": "36253", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19621.4, "discounted_cash": 6453, "minimum": 21.83, "maximum": 15697.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13680.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 13680.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10313.62, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6711.23, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 12906.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 12906.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 6775.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9034.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 10324.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 13203.06, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 13203.06, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 13203.06, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10002.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5162.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7623 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6697 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8130 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6905 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8711.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6646.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6453.11, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CORONARY INTERVENTION W AMI - SOI : 1", "code_information": [ { "code": "1741", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24848.64, "maximum": 27333.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27333.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27333.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 27333.5, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 24848.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24848.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24848.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24848.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25594.1, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 24848.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "INBORN ERRORS OF METABOLISM - SOI : 2", "code_information": [ { "code": "4232", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8468.9, "maximum": 9315.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9315.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9315.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 9315.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 8468.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8468.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8468.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8468.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8722.96, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8468.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Nicardipine Hcl Iv Soln 2.5 Mg/Ml - 00143959310", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "00143959310", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Lipoprotein Bld By Nmr", "code_information": [ { "code": "83704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.51, "discounted_cash": 34, "minimum": 20.51, "maximum": 240.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 72.48, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.58, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 68.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 68.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 35.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 47.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 41.03 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 70.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 70.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.51 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 34.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 34.19 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fetal Chromosomal Microdeltj Genomic Seq Analys", "code_information": [ { "code": "81422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3150, "discounted_cash": 759, "minimum": 419.895, "maximum": 2520, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1609.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1609.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1100.62, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 789.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1518.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1518.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 797, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1062.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 910.86, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 741.83, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 741.83, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 741.83, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1176.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 607.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 455.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 455.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 759.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 759.05 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 607.24 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1024.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 781.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Psychotherapy W/Patient 60 Minutes", "code_information": [ { "code": "90837", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 713.56, "discounted_cash": 205, "minimum": 79.31, "maximum": 570.848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 436.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.23 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 328.98, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 411.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 411.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 216.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 288.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 329.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 421.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 421.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 421.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 104.61, "10th_percentile": 92.37, "90th_percentile": 104.61, "count": "22" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Imaging, Whole Body, Single Day", "code_information": [ { "code": "78802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6833.64, "discounted_cash": 629, "minimum": 483.6, "maximum": 5466.912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1334.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1334.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 483.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1006.38, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 654.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1259.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1259.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 661.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 881.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1007.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 976, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 503.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1958.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1958.91 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1305.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1305.94 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 648.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "URINARY STONES WITH MCC", "code_information": [ { "code": "693", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18675, "minimum": 8262.54, "maximum": 33801.8948, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 33801.89, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 33801.89, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15502.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15502.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22775.83 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16122.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 31747.64, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 31747.64, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 19608.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24277.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 29880.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 30882 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15502.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 8262.54 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 15502.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18675.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24029.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18675.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15518.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15502.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22174.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15502.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19518.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 23647.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20078.76 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25211.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15967.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15502.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - 80329 - 30100036", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 469.16, "minimum": 16.48, "maximum": 375.328, "payers_information": [ { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 137.56, "10th_percentile": 137.56, "90th_percentile": 137.56, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35940, "minimum": 17134.97, "maximum": 65052.8118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 65052.81, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 65052.81, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 29215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 48287.47 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 30383.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 61099.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 61099.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 37737.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 46723.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 57505.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 61255 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 29215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 17134.97 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 29215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 35940.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45283.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27917.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 29215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47013.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41380.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 50134.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 42569.37 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 48520.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30091.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 29215.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholn Rcptr Blckg Antb", "code_information": [ { "code": "86042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92, "discounted_cash": 18, "minimum": 11.04, "maximum": 73.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 39.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.04 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 3", "code_information": [ { "code": "0423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14361.07, "maximum": 15797.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15797.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15797.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 15797.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 14361.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14361.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14361.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14361.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14791.9, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14361.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PEPTIC ULCER & GASTRITIS - SOI : 1", "code_information": [ { "code": "2411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7655.54, "maximum": 8421.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8421.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8421.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 8421.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 7655.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7655.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7655.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7655.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7885.2, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7655.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Gi Protein Loss Exam", "code_information": [ { "code": "78282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 463, "minimum": 114.452, "maximum": 1865.248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.45 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 482.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 486.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 649.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 718.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 370.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 625.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CCMCC", "code_information": [ { "code": "195", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10466, "minimum": 4287.33, "maximum": 18944.2202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18944.22, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 18944.22, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8983.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8983.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10646.79 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9342.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 17792.91, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 17792.91, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 10989.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13606.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 16746.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 13641 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8983.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 4287.33 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 8983.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10466.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13924.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10466.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7491.11 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8983.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10365.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8983.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9123.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 11054.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 9386.02 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14129.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9253.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8983.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 4", "code_information": [ { "code": "0894", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 68515.83, "maximum": 75367.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 75367.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 75367.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 75367.41, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 68515.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 68515.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 68515.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 68515.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 70571.31, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 68515.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Arterial Line Insertion", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 893.5, "minimum": 21.83, "maximum": 893.5, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 893.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 893.5 } ] } ] }, { "description": "Hc Tracheotomy Er Cricothroid Membrane", "code_information": [ { "code": "31605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3049, "discounted_cash": 274, "minimum": 21.83, "maximum": 3049, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 582.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 582.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 438.99, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 549.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 549.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 288.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 384.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 439.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 561.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 561.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 561.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 219.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3049 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 370.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Debride Nail 6 Or More", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 68, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 145.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.32, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 136.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 136.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 71.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 109.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 92.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rtrvl Intrvas Vc Filtr W/Wo Acs Vsl Selxn Rs&I", "code_information": [ { "code": "37193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11803, "discounted_cash": 3661, "minimum": 21.83, "maximum": 9442.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5852.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5126.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5858.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 1833.01, "10th_percentile": 1833.01, "90th_percentile": 1833.01, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5675.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 1730.32, "10th_percentile": 1730.32, "90th_percentile": 1730.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4943.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Curette/Treat Cornea", "code_information": [ { "code": "65435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310, "discounted_cash": 1156, "minimum": 21.83, "maximum": 13848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2450.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2450.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1156.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1156.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1847.68, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1202.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2312.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2312.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1213.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1618.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1849.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2365.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2365.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2365.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1156.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1156.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1156.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1791.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1156.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1156.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 924.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1156.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1560.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1156.07, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colonoscopy Thru Stoma Bleed Control", "code_information": [ { "code": "44391", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3365.98, "discounted_cash": 1387, "minimum": 21.83, "maximum": 3365.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2942.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2942.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2217.94, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1443.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2775.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2775.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1457.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1942.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2220.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2151, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1110.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3365.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3365.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3365.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3365.98 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1873.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1429.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [ { "code": "659", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32391, "minimum": 17023.85, "maximum": 58628.3254, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 58628.33, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 58628.33, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 26396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 43042.85 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 27452.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 55065.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 55065.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 34010.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 42108.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 51826.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 56451 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 26396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 17023.85 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 26396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 32391.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 40914.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32391.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31999.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41907.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26396.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36886.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 44689.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 37945.8 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 43728.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27188.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 26396.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PROCEDURES FOR OBESITY - SOI : 4", "code_information": [ { "code": "4034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 52848.96, "maximum": 58133.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 58133.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 58133.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 58133.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 52848.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 52848.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 52848.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 52848.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 54434.43, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 52848.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE - SOI : 1", "code_information": [ { "code": "6301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27586.52, "maximum": 30345.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 30345.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30345.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 30345.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 27586.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27586.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27586.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27586.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 28414.12, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 27586.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Remove Pilonidal Cyst Exten", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22601.3, "discounted_cash": 3368, "minimum": 21.83, "maximum": 18081.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5383.8, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3537.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4716.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5389.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5221.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2694.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4547.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3469.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "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": 22829, "minimum": 10316.4, "maximum": 41322.0285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 41322.03, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 41322.03, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18802.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18802.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 28914.89 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19554.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 38810.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 38810.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 23971.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29678.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 36527.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 32221 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 18802.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10674.01 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 18802.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 22829.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29143.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22829.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10316.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18802.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28151.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18802.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24779.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 30020.96 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 25490.84 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30820.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19366.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18802.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Neck/Hnd/Ft/Gent 7.6-12.5 Cm", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192, "discounted_cash": 857, "minimum": 21.83, "maximum": 1192, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 891.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 899.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1192, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 685.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1192 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1192 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1157.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 882.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood,Freezing", "code_information": [ { "code": "86930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.35, "discounted_cash": 197, "minimum": 50.7007, "maximum": 418.8696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 380.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 380.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.78, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 380.35, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 380.35, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 207.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 276.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 316.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 380.35, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 380.35, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 380.35, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 266.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Proctosgmdsc Rigid Control Bleeding", "code_information": [ { "code": "45317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4683.45, "discounted_cash": 1387, "minimum": 21.83, "maximum": 4683.45, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2151, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1110.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4683.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1873.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1429.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2942.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2942.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2217.94, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1443.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2775.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2775.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1457.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1942.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2220.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL & OTHER VASCULAR DISORDERS - SOI : 3", "code_information": [ { "code": "1973", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11181.06, "maximum": 12299.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12299.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12299.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 12299.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 11181.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11181.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11181.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11181.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11516.49, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11181.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204, "discounted_cash": 14, "minimum": 8.68, "maximum": 163.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 30.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 28.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 17.35 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 48.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 48.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37958.1, "maximum": 41753.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 41753.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 41753.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 41753.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 37958.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 37958.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 37958.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 37958.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 39096.84, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 37958.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS - SOI : 2", "code_information": [ { "code": "8932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10241.35, "maximum": 11265.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11265.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11265.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 11265.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 10241.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10241.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10241.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10241.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10548.59, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10241.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Pelvis 1/2 Vw", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 789.11, "discounted_cash": 121, "minimum": 43.524, "maximum": 631.288, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.52 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 122.55, "10th_percentile": 122.55, "90th_percentile": 122.55, "count": "13" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 115.68, "10th_percentile": 115.68, "90th_percentile": 115.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 115.68, "10th_percentile": 115.68, "90th_percentile": 115.68, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS - SOI : 4", "code_information": [ { "code": "1304", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 66472.71, "maximum": 73119.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 73119.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 73119.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 73119.98, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 66472.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 66472.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 66472.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 66472.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 68466.89, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 66472.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Esmolol Hcl Inj 100 Mg/10Ml - 67457018200", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "67457018200", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34286, "minimum": 16817.85, "maximum": 62058.4564, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 62058.46, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 62058.46, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27901.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 27901.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 45843.03 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 29017.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 58286.95, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 58286.95, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 36000.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 44572.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 54858.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 56540 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 27901.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 16817.85 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 27901.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 34286.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43247.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34286.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40054.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 27901.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44633.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27901.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 39285.91 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 47596.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 40414.39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 46286.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28738.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 27901.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "254", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23687, "minimum": 11298.88, "maximum": 42874.2121, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 42874.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 42874.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19483.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19483.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 30182 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 20262.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 40268.6, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 40268.6, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 24871.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 30793.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 37899.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 37834 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19483.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 11298.88 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 19483.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 23687.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30199.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23687.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31182.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19483.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29385.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19483.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25864.94 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 31336.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 26607.91 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31978, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20068.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19483.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tracheotomy Planned", "code_information": [ { "code": "31600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 3844, "minimum": 21.83, "maximum": 8694.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8151.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8151.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6145.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3998.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7689.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7689.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4037.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5382.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6151.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5959.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3075.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5190.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3960.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Alcohol And/Or Drug Screenin", "code_information": [ { "code": "H0003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4.76, "minimum": 1, "maximum": 4.76, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.76 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 0.63, "10th_percentile": 0.63, "90th_percentile": 0.63, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 0.7, "10th_percentile": 0.7, "90th_percentile": 0.7, "count": "1 through 10" } ] } ] }, { "description": "Hc Repair Lip,>1/2 Vert Height", "code_information": [ { "code": "40654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5192.75, "discounted_cash": 1799, "minimum": 21.83, "maximum": 4842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3814.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3814.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2875.81, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1871.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3598.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3598.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1889.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2519.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2878.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3681.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3681.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3681.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2789.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1439.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2429.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1853.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drug Assay Leflunomide", "code_information": [ { "code": "80193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.85, "discounted_cash": 38, "minimum": 23.14, "maximum": 154.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.77, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 81.77, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.11, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 77.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 77.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 40.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 46.28 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 45.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.14 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 38.57 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.86 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55387, "minimum": 26702.19, "maximum": 100250.5605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 100250.56, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 100250.56, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44659.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 44659.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 77021.1 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 46445.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 94157.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 94157.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 58156.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 72003.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 88619.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 96291 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 44659.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 26702.19 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 44659.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 55387.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 69222.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55387.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57233.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 44659.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 74988.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 44659.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 66004.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 79967.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 67900.42 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 74772.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45999.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 44659.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Endovasc Intracranial Prlng Admin Rx Agent, Addl", "code_information": [ { "code": "61651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4287.9, "minimum": 21.83, "maximum": 3861, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3622 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2090 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3861 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2155 } ] } ] }, { "description": "Hc Nm Brain Imaging < 4 Static Views W Vascular Flow", "code_information": [ { "code": "78601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 463, "minimum": 256.308, "maximum": 1865.248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 256.31 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 482.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 486.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 649.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 718.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 370.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 625.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Plc Cath Subselect Art,Neck", "code_information": [ { "code": "36216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3381, "minimum": 21.83, "maximum": 3097, "payers_information": [ { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 } ] } ] }, { "description": "Hc Bx Breast W Device Stereotact Guide Addl Lesion", "code_information": [ { "code": "19082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2625.31, "minimum": 349.9538, "maximum": 2625.31, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2625.31 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2625.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 } ] } ] }, { "description": "TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES - SOI : 2", "code_information": [ { "code": "8162", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7071.62, "maximum": 7778.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7778.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7778.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 7778.79, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 7071.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7071.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7071.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7071.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7283.77, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7071.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Excision Pilonidal Cyst/Sinus Complicated", "code_information": [ { "code": "11772", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11624, "discounted_cash": 3368, "minimum": 21.83, "maximum": 14619.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5383.8, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3537.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4716.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5389.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5221.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2694.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4547.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3469.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Microslide Consult W Slide Prep", "code_information": [ { "code": "88323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 430, "discounted_cash": 60, "minimum": 29.68, "maximum": 344, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 128.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.58, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 120.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 120.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 84.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 96.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 49.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 49.47 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.02 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remvl Perm Pm Pls Gen W/Repl Plse Gen Mult Ld Sys", "code_information": [ { "code": "33229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93056.3, "discounted_cash": 22337, "minimum": 21.83, "maximum": 74445.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47355.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 47355.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35701.02, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23231.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 44675.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 44675.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 23454.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31272.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 35740.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 45702.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45702.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 45702.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34623.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17870.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8705 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7645 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 9284 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 7882 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30155.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23007.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22337.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hysteroscopy Remove Myoma", "code_information": [ { "code": "58561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18415.6, "discounted_cash": 5801, "minimum": 21.83, "maximum": 14732.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12298.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 12298.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9271.89, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6033.36, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 11602.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 11602.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 6091.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8121.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 9282.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 11869.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 11869.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 11869.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 6048.55, "10th_percentile": 6048.55, "90th_percentile": 6048.55, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8992.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4641.05, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7831.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5975.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5801.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [ { "code": "516", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27085, "minimum": 11769.56, "maximum": 49024.7912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 49024.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 49024.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22182.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 22182.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 35203.01 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 23069.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 46045.38, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 46045.38, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 28439.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35211.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 43336.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 44500 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 22182.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 11769.56 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 22182.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 27085.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34382.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27085.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32963.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 22182.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34274.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22182.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30167.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 36549.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 31034.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 36565.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22847.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 22182.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "574", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43059, "minimum": 19013.95, "maximum": 77937.0796, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 77937.08, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 77937.08, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 34868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 34868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 58805.52 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 36263.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 73200.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 73200.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 45212.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 55976.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 68894.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 74263 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 34868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 19013.95 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 34868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 43059.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 54046.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43059.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30359.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 34868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 57253.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34868.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 50394.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 61054.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 51841.89 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 58129.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35914.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 34868.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Breast Loc Dev Place Mri Guide Addl Lesion", "code_information": [ { "code": "19288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2116.92, "minimum": 282.1854, "maximum": 2116.92, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2116.92 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2116.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2116.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2116.92 } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "724", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10778, "minimum": 4302.31, "maximum": 19508.6325, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 19508.63, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 19508.63, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11107.56 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9600.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 18323.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 18323.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 11317.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14011.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 17245.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 17651 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 4302.31 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 9231.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10778.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14308.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10778.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10833.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10814.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9231.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9518.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 11532.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 9792.22 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14550.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9508.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9231.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERM CARDIAC PACEMAKER IMPLANT WO AMI, HEART FAILURE OR SHOCK - SOI : 4", "code_information": [ { "code": "1714", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46439.89, "maximum": 51083.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 51083.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 51083.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 51083.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 46439.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 46439.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 46439.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 46439.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 47833.09, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 46439.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "TRACHEOSTOMY W MV 96+ HOURS WO EXTENSIVE PROCEDURE - SOI : 2", "code_information": [ { "code": "0052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 62899.47, "maximum": 69189.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 69189.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 69189.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 69189.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 62899.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 62899.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 62899.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 62899.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 64786.46, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 62899.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Dist Fibula Fx W Manip", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 286, "minimum": 133.1867, "maximum": 999.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10488, "minimum": 4077.58, "maximum": 18983.642, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 18983.64, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 18983.64, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9000.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9000.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 10678.98 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9360.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 17829.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 17829.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 11012.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 13634.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 16781.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 13807 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9000.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 4077.58 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 9000.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 10488.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13951.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10488.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9140.17 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9000.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10397.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9000.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9151.52 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 11087.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 9414.39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 14159.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9270.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9000.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH CC", "code_information": [ { "code": "593", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16861, "minimum": 7050.25, "maximum": 30519.0978, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30519.1, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 30519.1, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14062.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14062.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20095.92 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14624.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 28664.35, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 28664.35, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 17704.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21919.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 26978.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 26382 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14062.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 7050.25 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 14062.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16861.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21796.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16861.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8840.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14062.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19565.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14062.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17221.52 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 20864.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 17716.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22762.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14484.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14062.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE- SOI : 3", "code_information": [ { "code": "8173", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10330.28, "maximum": 11363.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11363.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11363.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 11363.31, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 10330.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10330.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10330.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10330.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10640.19, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10330.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Knee 4+ View", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 733.47, "discounted_cash": 121, "minimum": 56.42, "maximum": 586.776, "payers_information": [ { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 113.91, "10th_percentile": 113.91, "90th_percentile": 113.91, "count": "29" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 440.08, "10th_percentile": 440.08, "90th_percentile": 440.08, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 107.53, "10th_percentile": 107.53, "90th_percentile": 107.53, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 56.42 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "832", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11533, "minimum": 4487.09, "maximum": 20876.1237, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20876.12, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 20876.12, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9831.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9831.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 12223.9 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 10224.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 19607.41, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 19607.41, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 12110.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14993.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 18454.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 16086 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9831.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 4487.09 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 9831.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11533.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15238.36, "additional_payer_notes": "155.00% 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": 5970.65 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9831.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11901.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9831.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10475.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 12691.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 10776.37 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15570.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10126.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9831.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hepatitis Panel,Acute", "code_information": [ { "code": "80074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 670, "discounted_cash": 47, "minimum": 28.58, "maximum": 536, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 100.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 335, "10th_percentile": 335, "90th_percentile": 335, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.06, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 95.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 95.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 50.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 57.16 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 157.79, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 157.79, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.79, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 73.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 28.58 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 47.63 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 47.63 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 98.22, "10th_percentile": 98.22, "90th_percentile": 98.22, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of C-Peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293, "discounted_cash": 20, "minimum": 12.49, "maximum": 234.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 44.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.17, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 69, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 69, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 69, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prq Drug Eluting Cor Revasc Chro Add - C9608 - 48100200", "code_information": [ { "code": "C9608", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10388, "minimum": 21.83, "maximum": 8310.4, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 } ] } ] }, { "description": "Hc Angrph Cath F-Up Std Tcat Othr Than Thrombylsis", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4788.91, "discounted_cash": 3661, "minimum": 220.844, "maximum": 4788.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 220.84 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% 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": 15390, "discounted_cash": 1915, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 2256.17, "10th_percentile": 2256.17, "90th_percentile": 2256.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Med Malleolus Fx W Manip", "code_information": [ { "code": "27762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1864, "minimum": 811.4104, "maximum": 4869.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2980.37, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1939.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1958.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2610.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2983.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1491.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1920.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Multiple Vitamin Inj", "drug_information": { "unit": 5, "type": "ML" }, "code_information": [ { "code": "54643564901", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Hla Class I&Ii Low Hla-A -B -C -Drb1/3/4/5&Dqb", "code_information": [ { "code": "81370", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2200, "discounted_cash": 402, "minimum": 241.27, "maximum": 1760, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 852.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 852.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 583.07, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 418.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 804.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 804.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 422.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 562.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 482.54, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 518.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 518.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 518.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 623.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 321.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 241.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 241.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 402.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 402.12 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.7 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 542.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 414.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 402.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Occup Therapy Evaluation, 30 Min", "code_information": [ { "code": "97003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.34, "minimum": 34.8806, "maximum": 1256, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5969.48, "maximum": 6566.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6566.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6566.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 6566.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 5969.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5969.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5969.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5969.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6148.56, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5969.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Humer Epicondylr Fx W Manip", "code_information": [ { "code": "24565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1864, "minimum": 811.4104, "maximum": 4869.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2980.37, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1939.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1958.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2610.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2983.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1491.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1920.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rubeola", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136, "discounted_cash": 12, "minimum": 7.73, "maximum": 108.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 27.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 32.03, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 32.03, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.03, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Myomectomy Abdom Complex", "code_information": [ { "code": "58146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38952, "minimum": 21.83, "maximum": 31161.6, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 } ] } ] }, { "description": "SPLENECTOMY - SOI : 3", "code_information": [ { "code": "6503", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32483.53, "maximum": 35731.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 35731.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35731.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 35731.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 32483.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32483.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 32483.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 32483.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 33458.03, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 32483.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Fructose Semen", "code_information": [ { "code": "82757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.16, "discounted_cash": 17, "minimum": 10.4, "maximum": 210.528, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 61.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 61.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 13.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.34 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 36.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.14, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophagoscopy Flx Transoral Lesion Ablation", "code_information": [ { "code": "43229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9575.75, "discounted_cash": 4471, "minimum": 21.83, "maximum": 9478.8804, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9478.88, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9478.88, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7146, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4650.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8942.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 8942.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4694.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6259.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 7153.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 9148.01, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9148.01, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 9148.01, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6930.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3576.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6036.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4605.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inject Diskogram,Lumbar,Ea Level", "code_information": [ { "code": "62290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1411.09, "minimum": 21.83, "maximum": 1411.09, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1411.09 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1411.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1411.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1411.09 } ] } ] }, { "description": "Hc Nm Acute Gi Blood Loss Imaging", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 463, "minimum": 299.832, "maximum": 1865.248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 299.83 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 482.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 486.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 649.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 718.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 370.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 625.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Culture Specimen, Anaerobic", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129, "discounted_cash": 9, "minimum": 5.68, "maximum": 103.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 64.5, "10th_percentile": 64.5, "90th_percentile": 64.5, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.47 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.58 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 18.91, "10th_percentile": 18.91, "90th_percentile": 18.91, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 3", "code_information": [ { "code": "7593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16243.03, "maximum": 17867.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17867.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17867.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 17867.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 16243.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16243.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16243.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16243.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16730.32, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 16243.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mra Chest Wo Contrast - 71555 - 61800005", "code_information": [ { "code": "71555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3693, "minimum": 295.89, "maximum": 2954.4, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 443.84 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 443.84 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 295.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 295.89 } ] } ] }, { "description": "Hc I&D Forearm Deep Abscess", "code_information": [ { "code": "25028", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3581.2, "discounted_cash": 3794, "minimum": 21.83, "maximum": 3581.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3035.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3581.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3581.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3581.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3581.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3581.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES - SOI : 1", "code_information": [ { "code": "3121", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14553.17, "maximum": 16008.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16008.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16008.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 16008.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 14553.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14553.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14553.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14553.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14989.77, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14553.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17979, "minimum": 8398.63, "maximum": 32542.3158, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 32542.32, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 32542.32, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 21747.57 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15548.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 30564.61, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 30564.61, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 18878.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 23372.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 28766.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 27995 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 8398.63 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 14950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17979.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23172.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17979.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14454.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21173.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14950.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18636.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 22579.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 19172.27 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 24271.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 15398.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14950.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY - SOI : 1", "code_information": [ { "code": "6111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13965.38, "maximum": 15361.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15361.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15361.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 15361.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 13965.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13965.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13965.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13965.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14384.34, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 13965.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "KIDNEY TRANSPLANT - SOI : 4", "code_information": [ { "code": "4404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 113143.31, "maximum": 124457.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 124457.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 124457.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 124457.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 113143.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 113143.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 113143.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 113143.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 116537.61, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 113143.31, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Elbow 3+ Vw", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.72, "discounted_cash": 100, "minimum": 48.36, "maximum": 499.776, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.36 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.28, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 105.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 141.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 161.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 97.02, "10th_percentile": 97.02, "90th_percentile": 97.02, "count": "37" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 91.58, "10th_percentile": 91.58, "90th_percentile": 91.58, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 136.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mra Pelvis Wo Contrast - 72198 - 61800008", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4796, "minimum": 298.68, "maximum": 3836.8, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 448.02 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 448.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 298.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 298.68 } ] } ] }, { "description": "Hc Work Hardening Init 2 Hr", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "minimum": 92.6435, "maximum": 556, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158 }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 } ] } ] }, { "description": "RESPIRATORY MALIGNANCY - SOI : 4", "code_information": [ { "code": "1364", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22521.94, "maximum": 24774.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 24774.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 24774.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 24774.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 22521.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22521.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22521.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22521.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23197.6, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 22521.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ct Scan Abdomen/Pelvis W Contrast", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5307.25, "discounted_cash": 404, "minimum": 323.664, "maximum": 4245.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 857.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 857.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 511 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 646.62, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 809.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 809.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 424.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 566.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 647.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 824.22, "10th_percentile": 824.22, "90th_percentile": 824.22, "count": "326" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 1592.18, "10th_percentile": 1592.18, "90th_percentile": 1592.18, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 778.04, "10th_percentile": 707.46, "90th_percentile": 778.04, "count": "130" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 546.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 778.04, "10th_percentile": 707.46, "90th_percentile": 778.04, "count": "16" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CCMCC", "code_information": [ { "code": "976", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13610, "minimum": 5859.19, "maximum": 24634.1181, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 24634.12, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 24634.12, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11480.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11480.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 15291.74 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11939.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 23137.02, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 23137.02, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 14290.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 17693.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 21776.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 18432 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11480.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 5859.19 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 11480.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13610.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17794.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13610.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14913.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11480.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14888.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11480.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13104.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15876.69 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 13480.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 18373.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11824.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11480.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Frozen Blood,Freezing", "code_information": [ { "code": "86930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 197, "minimum": 50.7007, "maximum": 418.8696, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.78, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 207.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 276.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 316.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 266.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophagoscopy Retrograde Dilate Balloon/Other", "code_information": [ { "code": "43213", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 2225, "minimum": 21.83, "maximum": 3575.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3556.63, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2314.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2336.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3115.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3560.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3449.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1780.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3004.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2292.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Necropsy, Coroners", "code_information": [ { "code": "88045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1150, "minimum": 34.64, "maximum": 920, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.64 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 34.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 57.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 57.74 } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 918, "discounted_cash": 8, "minimum": 5.19, "maximum": 734.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 459, "10th_percentile": 459, "90th_percentile": 459, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 216.19, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 216.19, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.19, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 134.58, "10th_percentile": 134.58, "90th_percentile": 134.58, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 6.92, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 134.58, "10th_percentile": 8.65, "90th_percentile": 134.58, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nasal Endo Dx,Sphenoid Sinusoscopy", "code_information": [ { "code": "31235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6348.95, "discounted_cash": 2064, "minimum": 21.83, "maximum": 5079.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4375.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4375.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2064.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2064.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3298.99, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2146.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4128.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4128.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2167.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2889.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3302.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4223.23, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4223.23, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4223.23, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2064.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2064.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2064.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3199.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2064.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2064.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1651.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2064.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2786.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2126.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2064.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Proc Shoulder Arthrography/Ct/Mri", "code_information": [ { "code": "23350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 912, "minimum": 121.5696, "maximum": 912, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 912 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 912 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 912 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 912 } ] } ] }, { "description": "Hc Assay Phosphohexose Enzymes", "code_information": [ { "code": "84087", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.55, "discounted_cash": 10, "minimum": 6.44, "maximum": 123.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 21.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 21.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 36.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 36.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 8.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 10.73 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.58 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Intravasc Us,Heart,1St Vessel", "code_information": [ { "code": "92978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9094, "minimum": 21.83, "maximum": 7275.2, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 } ] } ] }, { "description": "Hc Needle Biopsy Of Pancreas", "code_information": [ { "code": "48102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7256.1, "discounted_cash": 1915, "minimum": 21.83, "maximum": 5804.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Dx/Ther Sbst Intrlmnr Lmbr/Sac Wo Img - 62326 - 36100065", "code_information": [ { "code": "62326", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2466.3, "discounted_cash": 1025, "minimum": 21.83, "maximum": 2466.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2174.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2174.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1639.35, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1066.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2051.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2051.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1077.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1436.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1641.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2098.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1589.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 820.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2466.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2466.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2466.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2466.3 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1384.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1056.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1025.72, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Family Psytx W/O Patient", "code_information": [ { "code": "90846", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 750, "discounted_cash": 205, "minimum": 99.975, "maximum": 600, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 436.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 436.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 120.26 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 328.98, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 214.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 411.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 411.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 216.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 288.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 329.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 421.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 421.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 421.15, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.94 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 319.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 277.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 212.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.84, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Breast W/Out&With Contrast W/Cad Unilateral", "code_information": [ { "code": "77048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1472.2, "minimum": 196.2443, "maximum": 1177.76, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 1147.74 }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 426.05 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 426.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 284.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 284.03 } ] } ] }, { "description": "Hc Autoimmune Rheumatoid Arthr, 12 Biomark", "code_information": [ { "code": "81490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39, "discounted_cash": 840, "minimum": 5.1987, "maximum": 39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000", "drug_information": { "unit": 50, "type": "ML" }, "code_information": [ { "code": "00409175550", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Cyp2C19 Gene Analysis Common Variants", "code_information": [ { "code": "81225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 899, "discounted_cash": 291, "minimum": 119.8367, "maximum": 719.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 617.68, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 422.47, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 582.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 582.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 305.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 407.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 349.63, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 211.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 211.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 211.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 451.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.09, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 174.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 174.82 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 291.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 291.36 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 393.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 291.36, "additional_payer_notes": "100.00% 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": 73520, "minimum": 44892.76, "maximum": 152244.055, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 133072.34, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 133072.34, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 59061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 59061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 103815.1 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 61423.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 124985.07, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 124985.07, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 77196.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 95576.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 117633.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 136196 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 59061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 44892.76 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 59061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 73520.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 91544.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 73520.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56270.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 59061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 101075.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59061, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 88965.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 107786.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 91521.53 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 99252.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 60832.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 59061, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC", "code_information": [ { "code": "278", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 67075, "minimum": 43715.6, "maximum": 121406.1482, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 121406.15, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 121406.15, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 53942.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 53942.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 94291.43 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 56099.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 114027.87, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 114027.87, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 70428.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 87197.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 107320.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 97259 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 53942.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 53942.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 67075.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 83610.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 67075.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43715.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 53942.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 91803.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 53942.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 80804.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 97898.33 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 83125.63 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 90551.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 55560.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 53942.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hiv-1", "code_information": [ { "code": "86701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192, "discounted_cash": 8, "minimum": 5.33, "maximum": 153.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 45.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.89 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR MALE PELVIC PROCEDURES - SOI : 4", "code_information": [ { "code": "4804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49652.18, "maximum": 54617.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 54617.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 54617.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 54617.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 49652.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 49652.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 49652.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 49652.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 51141.74, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 49652.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1622", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 63519.54, "maximum": 69871.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 69871.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 69871.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 69871.49, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 63519.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 63519.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 63519.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 63519.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 65425.12, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 63519.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY - SOI : 4", "code_information": [ { "code": "5114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 58287.38, "maximum": 64116.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 64116.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 64116.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 64116.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 58287.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 58287.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 58287.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 58287.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 60036, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 58287.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 500-749G WO MAJOR PROCEDURE - SOI : 4", "code_information": [ { "code": "5914", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 217206.69, "maximum": 238927.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 238927.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 238927.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 238927.35, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 217206.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 217206.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 217206.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 217206.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 223722.89, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 217206.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "SHOULDER & ELBOW JOINT REPLACEMENT - SOI : 4", "code_information": [ { "code": "3224", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46314.88, "maximum": 50946.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50946.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 50946.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 50946.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 46314.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 46314.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 46314.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 46314.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 47704.32, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 46314.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Removal Of Foreign Body", "code_information": [ { "code": "20525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23085, "discounted_cash": 3368, "minimum": 21.83, "maximum": 18468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5383.8, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3537.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4716.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5389.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5221.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2694.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4547.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3469.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Tranexamic Acid-Sodium Chloride Iv Soln 1000 Mg/100Ml-0.7%", "drug_information": { "unit": 100, "type": "ML" }, "code_information": [ { "code": "51754010801", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE - SOI : 2", "code_information": [ { "code": "7112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17052.59, "maximum": 18757.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18757.84, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18757.84, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 18757.84, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 17052.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17052.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17052.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17052.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17564.16, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17052.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Lrh Hormone", "code_information": [ { "code": "83727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.78, "discounted_cash": 17, "minimum": 10.31, "maximum": 168.624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 36.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.93, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 34.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 34.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 20.63 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 49.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 49.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 13.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.19 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES - SOI : 4", "code_information": [ { "code": "3474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23883.13, "maximum": 26271.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26271.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26271.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 26271.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 23883.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23883.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23883.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23883.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24599.63, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23883.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Blood Type Antigen Donor Reagent Serum, Ea Ag", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1608.72, "discounted_cash": 415, "minimum": 3.81, "maximum": 1286.976, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 881.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 881.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 664.36, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 831.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 831.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 436.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 581.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 665.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 332.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.81 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Diltiazem Hcl 125 Mg/125Ml In Dextrose 5% Iv Soln (1 Mg/Ml)", "drug_information": { "unit": 125, "type": "ML" }, "code_information": [ { "code": "70092157536", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Revasc Fem/Pop Art Angiopl/Stnt", "code_information": [ { "code": "37226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49236.1, "discounted_cash": 12872, "minimum": 21.83, "maximum": 50664.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27290.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 27290.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12872.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12872.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20573.81, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 25745.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 25745.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 13516.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18021.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 20596.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 26337.73, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26337.73, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 26337.73, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12872.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12872.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12872.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19952.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12872.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12872.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10298.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12872.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 9284 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 7882 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17378.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13258.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12872.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr 7.6-12.5 Cm", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1784.57, "discounted_cash": 471, "minimum": 21.83, "maximum": 1784.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 999.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 999.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 753.46, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 490.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 942.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 942.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 495, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 660, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 754.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 377.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1784.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1784.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1784.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1784.57 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 636.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Nasal Septal Fx", "code_information": [ { "code": "21337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 3844, "minimum": 1448.7711, "maximum": 8694.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8151.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8151.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6145.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3998.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7689.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7689.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4037.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5382.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6151.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5959.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3075.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5190.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3960.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colonoscopy,Remv Lesn,Snare", "code_information": [ { "code": "45385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5281.42, "discounted_cash": 1387, "minimum": 21.83, "maximum": 4842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2942.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2942.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "standard_charge_algorithm": "Not To Exceed $9088", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 2640.71, "10th_percentile": 1609.52, "90th_percentile": 2640.71, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2217.94, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1443.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2775.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2775.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1457.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1942.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2220.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 820.2, "10th_percentile": 499.92, "90th_percentile": 820.2, "count": "68" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2151, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1110.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 704.01, "10th_percentile": 471.91, "90th_percentile": 774.26, "count": "52" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1873.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1429.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Igk@ Gene Rearrange Detect Abnormal Clonal Pop", "code_information": [ { "code": "81264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2188, "discounted_cash": 172, "minimum": 103.64, "maximum": 1750.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 366.19, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.46, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 179.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 345.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 345.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 181.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 241.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 207.28, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 515.27, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 515.27, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 515.27, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 138.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 103.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 103.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 172.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 172.73 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.18 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 233.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 177.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.19, "additional_payer_notes": "212.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Interstitial Dev, Intra-Thoracic, Perq", "code_information": [ { "code": "32553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5331.2, "discounted_cash": 1605, "minimum": 21.83, "maximum": 4842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3402.96, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3402.96, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2565.45, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1669.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3210.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3210.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1685.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2247.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2568.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3284.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3284.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3284.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2488.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1284.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2166.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1653.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1605.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Cath In Artery, Slctv Addl 2Nd/3Rd Order, Thoracic/Brachioceph Branch", "code_information": [ { "code": "36218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11342, "minimum": 21.83, "maximum": 9073.6, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 } ] } ] }, { "description": "Hc Inpt/Ed Teleconsult50", "code_information": [ { "code": "G0426", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1258.55, "minimum": 134.78, "maximum": 1012, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 134.78 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "HORIZON CASUALTY SERVICES Personal Injury Protection - PIP", "methodology": "case rate", "standard_charge_dollar": 1012 }, { "payer_name": "Horizon", "plan_name": "HORIZON CASUALTY SERVICES Workers Comp", "methodology": "case rate", "standard_charge_dollar": 966 }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 282 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 430 } ] } ] }, { "description": "Hc Venogram Splenoportogram", "code_information": [ { "code": "75810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4788.91, "discounted_cash": 3661, "minimum": 638.3617, "maximum": 4788.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ethiodized Inj Oil 480 Mg/Ml (Iodine Equivalent)", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "67684190102", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "NEONATE BWT 2000-2499G W MAJOR ANOMALY - SOI : 2", "code_information": [ { "code": "6212", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16018.8, "maximum": 17620.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17620.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17620.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 17620.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 16018.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16018.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16018.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16018.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16499.36, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 16018.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS - SOI : 2", "code_information": [ { "code": "1372", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9720.58, "maximum": 10692.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10692.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10692.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 10692.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 9720.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9720.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9720.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9720.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10012.19, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9720.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 750-999G WO MAJOR PROCEDURE - SOI : 1", "code_information": [ { "code": "5931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2232.62, "maximum": 2455.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 2455.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 2455.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 2455.88, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 2232.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 2232.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 2232.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 2232.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 2299.6, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 2232.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ileoscopy Thru Stoma Stent W Dilation", "code_information": [ { "code": "44384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6618.67, "discounted_cash": 2225, "minimum": 21.83, "maximum": 5294.936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4717.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4717.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3556.63, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2314.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4450.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4450.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2336.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3115.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3560.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4553.05, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4553.05, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4553.05, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3449.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1780.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3004.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2292.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Iron Stain, Peripheral Blood", "code_information": [ { "code": "85536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.53, "discounted_cash": 6, "minimum": 4.13, "maximum": 91.624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.98, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "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": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Pet Brain Metabolic Eval", "code_information": [ { "code": "78608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9250.71, "discounted_cash": 1658, "minimum": 1233.1196, "maximum": 7400.568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3515.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3515.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1658.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 2337.4 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1658.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2650.36, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1724.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3316.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3316.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1741.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2321.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2653.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3392.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3392.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3392.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1658.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1658.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1658.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2570.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1658.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1658.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1326.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2220.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1658.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2220.51 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1480.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1480.34 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2238.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1708.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1658.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hearing Aid Exam Both Ears", "code_information": [ { "code": "92591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.21, "minimum": 46.2831, "maximum": 347.21, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 347.21 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 347.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 347.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 347.21 } ] } ] }, { "description": "Hc Group Psychotherapy Iop", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1151.88, "discounted_cash": 117, "minimum": 27.5, "maximum": 921.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 249.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 249.76, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.14 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 122.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 235.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 235.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 123.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 164.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 188.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 241.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 241.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 241.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 182.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 94.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 159.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 168.87, "10th_percentile": 51.5, "90th_percentile": 168.87, "count": "36" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.81, "additional_payer_notes": "100.00% 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": 744, "discounted_cash": 38, "minimum": 23.1, "maximum": 595.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.62, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 81.62, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.83, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 53.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 46.2 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 175.21, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 175.21, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.21, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 30.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 38.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 38.5 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.8 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.7, "discounted_cash": 154, "minimum": 76.2076, "maximum": 571.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.59, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 246.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 571.7 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Oral Function Therapy, 45 Min", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 786, "discounted_cash": 93, "minimum": 51.4498, "maximum": 838.4, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 92.23, "10th_percentile": 92.23, "90th_percentile": 92.23, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 125.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 197.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 186.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 186.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 97.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 130.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 111.92, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 185.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 185.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 93.27, "10th_percentile": 69.68, "90th_percentile": 161.89, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16230, "minimum": 7255.63, "maximum": 29377.7842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29377.78, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 29377.78, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13561.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13561.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19164.22 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14104.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 27592.39, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 27592.39, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 17042.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21100.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 25969.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 26140 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13561.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 7255.63 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 13561.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16230.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21020.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16230.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12408.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13561.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18658.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13561.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16423.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 19897.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 16894.83 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21911.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13968.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13561.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Xr Fluoro Guidance Cv/Picc Line", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 902.14, "minimum": 120.2553, "maximum": 721.712, "payers_information": [ { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 132.25, "10th_percentile": 132.25, "90th_percentile": 132.25, "count": "1 through 10" } ] } ] }, { "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, "minimum": 1.6063, "maximum": 12.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tee Transcath Maj Vessl Struct Intervention", "code_information": [ { "code": "93355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2435.4, "minimum": 324.6388, "maximum": 1948.32, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1817 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1599 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1939 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1649 } ] } ] }, { "description": "MAJOR BILIARY TRACT PROCEDURES - SOI : 1", "code_information": [ { "code": "2611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18433.16, "maximum": 20276.47, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20276.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20276.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 20276.47, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 18433.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18433.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18433.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18433.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18986.15, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18433.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189, "discounted_cash": 13, "minimum": 8.06, "maximum": 151.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 44.51, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 44.51, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.51, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Urinalysis Nonauto W/O Scope", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36, "discounted_cash": 3, "minimum": 2.09, "maximum": 28.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.62, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 4.18 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.78 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Stent Des Each Add Branch", "code_information": [ { "code": "C9601", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29112, "minimum": 21.83, "maximum": 23289.6, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 4267.82, "10th_percentile": 4267.82, "90th_percentile": 4267.82, "count": "1 through 10" } ] } ] }, { "description": "Hc Chest X-Ray 2 Vw", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.02, "discounted_cash": 100, "minimum": 54.808, "maximum": 335.216, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.81 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.28, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 105.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 141.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 161.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 65.07, "10th_percentile": 65.07, "90th_percentile": 65.07, "count": "550" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 125.71, "10th_percentile": 125.7, "90th_percentile": 1053.91, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 61.43, "10th_percentile": 55.86, "90th_percentile": 61.43, "count": "180" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 136.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 61.43, "10th_percentile": 55.86, "90th_percentile": 61.43, "count": "43" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE - SOI : 3", "code_information": [ { "code": "7403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30601.56, "maximum": 33661.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33661.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33661.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 33661.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 30601.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30601.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 30601.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30601.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 31519.61, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 30601.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Ige", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232, "discounted_cash": 16, "minimum": 9.88, "maximum": 185.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 34.9, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 32.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 32.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 19.75 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 54.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 54.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.17, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 1", "code_information": [ { "code": "5171", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8840.2, "maximum": 9724.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9724.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9724.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 9724.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 8840.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8840.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8840.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8840.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9105.41, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8840.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE - SOI : 1", "code_information": [ { "code": "0441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9302.9, "maximum": 10233.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10233.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10233.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 10233.19, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 9302.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9302.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9302.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9302.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9581.99, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9302.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Mra Chest W Contrast, Exclude Heart - C8909 - 61800004", "code_information": [ { "code": "C8909", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3322, "discounted_cash": 404, "minimum": 323.664, "maximum": 2657.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 857.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 857.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 646.62, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 809.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 809.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 424.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 566.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 647.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 546.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Small Bowel Endo Ablate Lesn", "code_information": [ { "code": "44369", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 2225, "minimum": 21.83, "maximum": 3575.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3556.63, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2314.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2336.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3115.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3560.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3449.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1780.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3004.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2292.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Xtrnl Ecg Continuous Rhythm W/I&R Up To 48 Hrs", "code_information": [ { "code": "93227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.57, "minimum": 29.402, "maximum": 220.57, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 220.57 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 220.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 220.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 220.57 } ] } ] }, { "description": "Hc Ct Scan Of Abdomen Combo", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3840.62, "discounted_cash": 203, "minimum": 162.728, "maximum": 3072.496, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 619.01 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 213.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 284.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 325.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 596.45, "10th_percentile": 596.45, "90th_percentile": 596.45, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 563.03, "10th_percentile": 563.03, "90th_percentile": 563.03, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 274.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Endovasc Taa Rew/O Subcl", "code_information": [ { "code": "33881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12025.4, "minimum": 21.83, "maximum": 9620.32, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2090 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3861 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2155 }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3622 } ] } ] }, { "description": "Hc Clsd Treat Mt-Phal Toe Disloc Wo Anes", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1315, "discounted_cash": 286, "minimum": 175.2895, "maximum": 1315, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1315 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1315 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1315 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1315 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Op Cardiac Rehab Wo Cont Ecg Monit Per Session", "code_information": [ { "code": "93797", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 551.1, "discounted_cash": 149, "minimum": 73.4616, "maximum": 551.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 316.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.92, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 298.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 298.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 156.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 209.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 239.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 305.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 305.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 305.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 149.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 149.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 149.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 119.59, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 551.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 149.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 551.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 551.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 551.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OPEN EXTRACRANIAL VASCULAR PROCEDURES- SOI : 2", "code_information": [ { "code": "0242", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16411.95, "maximum": 18053.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18053.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18053.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 18053.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 16411.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16411.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16411.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16411.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16904.31, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 16411.95, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Adenovirus Ag Eia", "code_information": [ { "code": "87301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 11, "minimum": 7.19, "maximum": 111.144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.98 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% 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": 39385, "minimum": 31951.3, "maximum": 71288.479, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 71288.48, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 71288.48, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31951.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 31951.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 53377.94 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 33229.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 66956.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 66956.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 41355.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 51201.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 63017.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 64730 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 31951.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 31951.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 39385.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49524.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39385.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53407.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 31951.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51969.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31951.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45743.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 55419.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 47057.03 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 53170.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32909.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 31951.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Protein Tot Refractometry Any Src", "code_information": [ { "code": "84160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.01, "discounted_cash": 5, "minimum": 3.37, "maximum": 84.008, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 11.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 11.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.49 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES - SOI : 2", "code_information": [ { "code": "2282", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14479.67, "maximum": 15927.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15927.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15927.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 15927.64, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 14479.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14479.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14479.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14479.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14914.06, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14479.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "727", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20261, "minimum": 8976.68, "maximum": 36673.8218, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36673.82, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 36673.82, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25120.33 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17433.52, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34445.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 34445.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 21274.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26340.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 32418.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 35346 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 8976.68 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20261.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25982.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20261.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21849.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24457.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21527.26 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26081.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22145.63 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27353.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17265.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16763, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Protein Tot Xcpt Refractometry Serum", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52, "discounted_cash": 3, "minimum": 2.2, "maximum": 41.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 26, "10th_percentile": 26, "90th_percentile": 26, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 4.4 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.94 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "956", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46402, "minimum": 23620.28, "maximum": 95191.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 83988.05, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 83988.05, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37523.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 37523.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 63745.22 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 39024.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 78883.81, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 78883.81, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 48722.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 60322.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 74243.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 84564 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 37523.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 23620.28 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 37523.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 46402.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 58161.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46402.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 95191.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 37523.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 62063.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37523.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 54627.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 66183.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 56196.64 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 62643.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 38649.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 37523.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 2000-2499G W CONGENITALPERINATAL INFECTION - SOI : 3", "code_information": [ { "code": "6233", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40635.38, "maximum": 44698.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 44698.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 44698.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 44698.92, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 40635.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 40635.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 40635.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 40635.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 41854.44, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 40635.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [ { "code": "564", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20957, "minimum": 9814.42, "maximum": 37933.4008, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37933.4, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 37933.4, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 17315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 26148.58 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 18008.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 35628.06, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 35628.06, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 22005.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27244.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 33532.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 34057 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 9814.42 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 17315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20957.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26839.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20957.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24161.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25458.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22408.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 27148.84 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 23052.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28292.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17835.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17315.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Remove Foreign Body Complex", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1915, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy W Ebus Sampling 1/2 Node", "code_information": [ { "code": "31652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9724.92, "discounted_cash": 4323, "minimum": 21.83, "maximum": 9166.35, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6701.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3459, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5837.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4453.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9166.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9166.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "standard_charge_algorithm": "Not To Exceed $9088", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 1375.85, "10th_percentile": 1375.85, "90th_percentile": 1375.85, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6910.39, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4496.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8647.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 8647.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4539.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6053.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6918, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8846.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8846.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8846.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Strapping Of Chest", "code_information": [ { "code": "29200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625.75, "discounted_cash": 188, "minimum": 83.4125, "maximum": 625.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 399.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 301.17, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 376.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 376.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 197.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 263.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 301.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 385.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 385.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 385.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 292.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 625.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 625.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 625.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 625.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Imag,Acute Venous Thrmbsis,Unilat", "code_information": [ { "code": "78457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6833.64, "discounted_cash": 629, "minimum": 232.128, "maximum": 5466.912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1334.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1334.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 232.13 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1006.38, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 654.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1259.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1259.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 661.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 881.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1007.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 976, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 503.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 648.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Repair Of Abdominal Wall", "code_information": [ { "code": "49900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19476, "minimum": 21.83, "maximum": 15580.8, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3622 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2090 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3861 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2155 } ] } ] }, { "description": "Hc Prep Wnd Trk/Ar/Lg Ea Add 100 Sqcm Or 1% Peds", "code_information": [ { "code": "15003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64, "minimum": 8.5312, "maximum": 64, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 64 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 64 } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20857, "minimum": 8502.87, "maximum": 37752.8714, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37752.87, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 37752.87, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17236.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 17236.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 26001.21 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17925.86, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 35458.5, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 35458.5, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 21900.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27115.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 33372.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 34112 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17236.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 8502.87 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 17236.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20857.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26716.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20857.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31192.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17236.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25315.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17236.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22282.14 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26995.82 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22922.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28158.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17753.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17236.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Enzyme Cell Activity Radioactv, Each Specimen", "code_information": [ { "code": "82658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.4, "discounted_cash": 44, "minimum": 26.42, "maximum": 177.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 93.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.84, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.79, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 88.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 88.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 46.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 61.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 52.84 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 44.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 44.03 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.03, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Head Combo", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3473, "discounted_cash": 203, "minimum": 162.728, "maximum": 2778.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 525.51 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 213.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 284.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 325.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 1041.9, "10th_percentile": 1041.9, "90th_percentile": 1041.9, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 274.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "497", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17113, "minimum": 8957.95, "maximum": 31124, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30975.62, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 30975.62, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14262.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14262.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20468.6 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14833.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29093.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 29093.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 17969.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22247.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 27381.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 31124 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14262.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 8957.95 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 14262.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17113.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22107.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17113.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19901.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14262.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19928.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14262.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17540.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 21251.58 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 18044.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23103.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14690.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14262.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.88, "discounted_cash": 5, "minimum": 3.11, "maximum": 75.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 10.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.14 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Urine Urea-N", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.75, "discounted_cash": 5, "minimum": 3.34, "maximum": 83.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.79, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 11.79, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 11.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 4.45, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.56 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.45 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 15.36, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ablation 1/> Liver Tumor Perq Cryoablation", "code_information": [ { "code": "47383", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20995.7, "discounted_cash": 12327, "minimum": 2798.7268, "maximum": 20995.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20995.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 20995.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12327.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12327.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19702.11, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12820.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 20995.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 20995.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 12943.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17258.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 19723.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 20995.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 20995.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 20995.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12327.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12327.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12327.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19107.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12327.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12327.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9861.9, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7623 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12327.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6697 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8130 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6905 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16641.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12697.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12327.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITH CCMCC", "code_information": [ { "code": "135", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28139, "minimum": 14346.46, "maximum": 57829, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 50931.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 50931.79, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23019.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 23019.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 36759.8 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 23939.86, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 47836.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 47836.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 29546.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 36580.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 45022.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 57829 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 23019.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 14346.46 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 23019.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 28139.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35679.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28139.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35852 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 23019.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35789.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23019.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31501.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 38165.96 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 32406.78 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37987.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23709.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 23019.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Plcmt Bile Duct Stent,New Access Wo Sep Cath", "code_information": [ { "code": "47539", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20995.7, "discounted_cash": 7010, "minimum": 21.83, "maximum": 16796.56, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9464.81, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7221.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14863.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14863.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11205.21, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7291.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 14021.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 14021.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 7361.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9815.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 11217.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 14344.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 14344.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 14344.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10867, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5608.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7623 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7010.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6697 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 8130 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 6905 } ] } ] }, { "description": "Hc Echo Heart,Transesophageal,Complete - C8925 - 48300003", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2654.92, "discounted_cash": 909, "minimum": 21.83, "maximum": 2866.752, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1927.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1927.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1452.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1818.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1818.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 954.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1272.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1454.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1409.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 727.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1817 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1599 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1939 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1649 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 936.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Human Epididymis Protein 4 (He4)", "code_information": [ { "code": "86305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327, "discounted_cash": 20, "minimum": 12.49, "maximum": 261.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 44.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.17, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 77.01, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 77.01, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.01, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 20.81 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22297, "minimum": 10526.06, "maximum": 40359.1809, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 40359.18, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 40359.18, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18380, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18380, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 28128.87 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19115.2, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 37906.41, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 37906.41, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 23412.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 28987.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 35676.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 32917 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 18380, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10526.06 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 18380, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 22297.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28489, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22297.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24721.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18380, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27386.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18380, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24105.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 29204.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 24797.91 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 30102.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18931.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18380, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Storage/Year Reprod Tissue", "code_information": [ { "code": "89344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511, "discounted_cash": 197, "minimum": 68.1163, "maximum": 418.8696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.78, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 207.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 276.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 316.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 266.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Diagnostic Bone Marrow Biopsies & Aspirations", "code_information": [ { "code": "38222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12717.2, "discounted_cash": 3368, "minimum": 21.83, "maximum": 10173.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5383.8, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3537.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4716.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5389.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5221.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2694.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4547.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3469.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Eval,Oral & Pharyngeal Swallow Function, 90 Min", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1792, "discounted_cash": 62, "minimum": 48.7212, "maximum": 1433.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 133.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 125.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 125.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 65.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 87.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 75.35, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 422.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 422.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 422.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 93.09, "10th_percentile": 56.76, "90th_percentile": 143.76, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 93.09, "10th_percentile": 93.09, "90th_percentile": 93.09, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.79, "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": 24218, "minimum": 11166.54, "maximum": 43834.9782, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 43834.98, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 43834.98, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 19905.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 19905.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 30966.32 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 20701.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 41170.97, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 41170.97, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 25429.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 31483.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 38749.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 39037 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 19905.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 11166.54 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 19905.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 24218.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30853.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24218.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22694.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 19905.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30149.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19905.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26537.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 32150.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 27299.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 32694.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20502.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 19905.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rbc Sed Rate, Auto", "code_information": [ { "code": "85652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.2, "discounted_cash": 2, "minimum": 1.62, "maximum": 84.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3.24 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 24.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 24.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2.7 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.16 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Destruct Internal Hemorrhoid, Thermal", "code_information": [ { "code": "46930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3338.35, "discounted_cash": 1387, "minimum": 21.83, "maximum": 3338.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2942.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2942.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2217.94, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1443.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2775.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2775.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1457.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1942.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2220.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2839.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2151, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1110.19, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3338.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3338.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3280 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1873.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1429.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1387.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS & INJURIES - SOI : 3", "code_information": [ { "code": "0403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21772.99, "maximum": 23950.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23950.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23950.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 23950.29, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 21772.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21772.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21772.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21772.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22426.18, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21772.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES- SOI : 4", "code_information": [ { "code": "1434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21162.02, "maximum": 23278.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23278.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23278.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 23278.22, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 21162.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21162.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21162.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21162.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21796.88, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21162.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Ankle 3+ Vw", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.96, "discounted_cash": 100, "minimum": 46.748, "maximum": 427.968, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.75 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.28, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 105.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 141.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 161.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 83.08, "10th_percentile": 83.08, "90th_percentile": 83.08, "count": "140" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 78.43, "10th_percentile": 78.43, "90th_percentile": 78.43, "count": "65" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 136.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 78.43, "10th_percentile": 71.31, "90th_percentile": 78.43, "count": "14" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs rsc prx phlx bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7933.75, "discounted_cash": 3794, "minimum": 21.83, "maximum": 7933.75, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5881.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3035.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5122.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3908.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7933.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7933.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6064.57, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3984.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5312.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6071.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc M.Pneumon Dna Quant", "code_information": [ { "code": "87582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.92, "discounted_cash": 302, "minimum": 45.4446, "maximum": 340.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 314.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 317.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 340.92 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.1, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 181.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 181.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 302.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 302.62 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 242.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 340.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 311.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.62, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [ { "code": "974", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36347, "minimum": 16998.26, "maximum": 65789.4637, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 65789.46, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 65789.46, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 29538.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 29538.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 48888.84 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 30719.94, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 61791.21, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 61791.21, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 38165.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 47252.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 58156.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 63594 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 29538.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 16998.26 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 29538.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 36347.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 45784.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36347.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 61999.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 29538.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 47598.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 29538.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41896.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 50758.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 43099.52 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49069.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30424.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 29538.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Digital Breast Tomosynthesis Bilat - 77062 - 40100011", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493.2, "minimum": 65.7436, "maximum": 394.56, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.23 }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 175.34 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 175.34 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 116.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 116.89 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 72.3, "10th_percentile": 72.3, "90th_percentile": 72.3, "count": "1 through 10" } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.1, "discounted_cash": 154, "minimum": 66.6633, "maximum": 500.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.59, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 246.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 500.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 500.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 500.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 500.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Incision Of Anal Abscess", "code_information": [ { "code": "46050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 1078, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2286.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2286.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1723.64, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1121.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2156.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2156.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1132.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1509.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1725.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2206.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2206.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2206.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1671.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 862.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3622 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3861 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3280 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1455.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1110.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS WITH MCC", "code_information": [ { "code": "592", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25448, "minimum": 10663.4, "maximum": 46061.5497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 46061.55, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 46061.55, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20882.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 20882.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 32783.98 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 21717.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 43262.23, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 43262.23, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 26720.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 33082.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 40717.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 45575 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 20882.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10663.4 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 20882.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 25448.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32367.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25448.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30576.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20882.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31918.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20882.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28094.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 34038.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 28901.77 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 34355.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21508.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20882.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc I&D Thigh/Knee Abscess,Deep", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10744.5, "discounted_cash": 3368, "minimum": 21.83, "maximum": 8595.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5383.8, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3537.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4716.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5389.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5221.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2694.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4547.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3469.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Injection Air/Contrast Peritoneal Cavity Spx", "code_information": [ { "code": "49400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2785, "minimum": 371.2405, "maximum": 2785, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2785 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2785 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 } ] } ] }, { "description": "Hc Echo Tthrc R-T 2D W/Wo M-Mode Rst&Strs Cont Ecg", "code_information": [ { "code": "93351", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4223, "discounted_cash": 633, "minimum": 499.6084, "maximum": 3378.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1343.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1343.38, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1012.76, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 659.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1267.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1267.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 665.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 887.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1013.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1296.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1296.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1296.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 982.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 506.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1817 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1599 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1939 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1649 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 855.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 652.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 633.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hospital Discharge Day Management > 30 Min", "code_information": [ { "code": "99239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.62, "minimum": 14.479, "maximum": 108.62, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "case rate", "standard_charge_dollar": 108.62 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 108.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MAGELLAN BEHAVIORAL HEALTH (CENTENE)", "plan_name": "MAGELLAN BEHAVIORAL HEALTH (CENTENE)", "methodology": "fee schedule", "standard_charge_dollar": 108.62 }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 108.62 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 108.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 108.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 108.62 } ] } ] }, { "description": "SICKLE CELL ANEMIA CRISIS - SOI : 1", "code_information": [ { "code": "6621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6343.32, "maximum": 6977.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6977.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6977.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 6977.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 6343.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6343.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6343.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6343.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6533.62, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6343.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Iadna-Dna/Rna Gi Pthgn Multiplex Probe Tq 6-11", "code_information": [ { "code": "87506", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1317.45, "discounted_cash": 262, "minimum": 157.79, "maximum": 1053.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 557.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 557.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 381.34, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 273.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 525.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 525.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 276.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 368.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 315.59 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 310.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 310.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 310.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 407.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 210.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 157.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 157.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 262.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 262.99 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 210.39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 355.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.99, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Iridotomy/Irridectomy Laser Surg Per Session", "code_information": [ { "code": "66761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2349.35, "discounted_cash": 637, "minimum": 21.83, "maximum": 2349.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1352.2, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1352.2, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1019.41, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 663.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1275.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1275.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 669.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 892.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1020.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1305, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1305, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1305, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 637.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 637.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 988.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 637.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 510.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2349.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 637.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2349.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2349.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2349.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 861.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 637.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Thumb Fx/Disloc W Manip", "code_information": [ { "code": "26645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1864, "minimum": 811.4104, "maximum": 4869.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2980.37, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1939.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1958.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2610.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2983.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1491.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1920.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 4", "code_information": [ { "code": "7594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 45348.1, "maximum": 49882.91, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 46708.55, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 45348.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 49882.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 49882.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 49882.91, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 45348.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 45348.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 45348.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 45348.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Phys Therapy Evaluation, 90 Min", "code_information": [ { "code": "97001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1570, "minimum": 34.8806, "maximum": 1256, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 } ] } ] }, { "description": "Hc Assay Of Magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94, "discounted_cash": 6, "minimum": 4.02, "maximum": 75.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.2, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 14.2, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 47, "10th_percentile": 17.43, "90th_percentile": 47, "count": "11" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 5.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 6.7 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.36 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 13.78, "10th_percentile": 6.7, "90th_percentile": 13.78, "count": "25" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Smear Complex Stain", "code_information": [ { "code": "87209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223, "discounted_cash": 17, "minimum": 10.79, "maximum": 178.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 38.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 52.52, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 52.52, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.52, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 29.73, "10th_percentile": 29.73, "90th_percentile": 29.73, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Prox/Mid Fing Shft Fx Wo Manip Ea", "code_information": [ { "code": "26720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1070, "discounted_cash": 286, "minimum": 142.631, "maximum": 1070, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1070 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1070 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1070 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1070 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc B-12 Binding Capacity", "code_information": [ { "code": "82608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201, "discounted_cash": 14, "minimum": 8.59, "maximum": 160.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 47.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 11.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.46 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Repair fingerhand tendon - 26350 - ", "code_information": [ { "code": "26350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 961.87, "discounted_cash": 3794, "minimum": 21.83, "maximum": 961.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 961.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 961.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 961.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 961.87 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 961.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venogram Infer Vena Cava", "code_information": [ { "code": "75825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16524.2, "discounted_cash": 3661, "minimum": 2202.6759, "maximum": 13219.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5852.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5126.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5858.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5675.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4943.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hpv Low-Risk Types", "code_information": [ { "code": "87623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 495, "discounted_cash": 35, "minimum": 21.05, "maximum": 396, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 74.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 116.57, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 116.57, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.57, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.07 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exc Skin Benig <0.5 Cm Scalp/Neck/Hnd/Ft/Gent", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1915, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3622 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3861 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3280 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Prostate Specific Antigen,Free", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229, "discounted_cash": 18, "minimum": 11.03, "maximum": 183.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 38.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 36.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 36.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 22.07 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 53.93, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 53.93, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.93, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 14.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 18.39 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 33.57, "10th_percentile": 33.57, "90th_percentile": 33.57, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Eeg Cont Rec W/Video By Tech Min 8 Channels", "code_information": [ { "code": "95700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1322.25, "discounted_cash": 250, "minimum": 176.2559, "maximum": 1322.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 530.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 530.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.2, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 500.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 500.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 262.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 350.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 400.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 388.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1322.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1322.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1322.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1322.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 338.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Thermoplasty =>2 Lobes", "code_information": [ { "code": "31661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15451.8, "discounted_cash": 8184, "minimum": 21.83, "maximum": 15451.8, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11049.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8430.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13080.81, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8511.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 8593.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11458.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 13095.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12685.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6547.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "419", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18919, "minimum": 8141.44, "maximum": 34243.8787, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34243.88, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 34243.88, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15696.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15696.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 23136.65 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16324.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 32162.76, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 32162.76, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 19865.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24595.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 30270.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 28634 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15696.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 8141.44 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 15696.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18919.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24330.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18919.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20956.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15696.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22526.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15696.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19827.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 24021.69 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20396.86 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25541.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16167.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15696.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fibrinolytic Plasminogen - 85415 - 30500076", "code_information": [ { "code": "85415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.6, "discounted_cash": 17, "minimum": 10.31, "maximum": 168.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 36.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.93, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 34.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 34.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 20.63 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 49.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 49.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 13.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.19 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Xray Hips W Pelvis, Bilat =>5 Vw", "code_information": [ { "code": "73523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1581.37, "discounted_cash": 121, "minimum": 96.984, "maximum": 1265.096, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 134.63 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 245.59, "10th_percentile": 245.59, "90th_percentile": 245.59, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Myelography Lumbar Inj, Lumboscral", "code_information": [ { "code": "62304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2307, "discounted_cash": 909, "minimum": 21.83, "maximum": 2307, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1927.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1927.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1452.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1818.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1818.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 954.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1272.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1454.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1409.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 727.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 936.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Oral Function Therapy, 30 Min", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524, "discounted_cash": 93, "minimum": 51.4498, "maximum": 838.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 197.73, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 186.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 186.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 97.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 130.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 111.92, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 93.27, "10th_percentile": 69.68, "90th_percentile": 161.89, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 92.23, "10th_percentile": 92.23, "90th_percentile": 92.23, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 125.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 96.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Relieve inner eye pressure", "code_information": [ { "code": "65820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11540, "discounted_cash": 4793, "minimum": 21.83, "maximum": 10162.2412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10162.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10162.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4793.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4793.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7661.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4985.25, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9587.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 9587.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 5033.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6710.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 7669.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 9807.52, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9807.52, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 9807.52, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4793.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 1792.16, "10th_percentile": 1792.16, "90th_percentile": 1792.16, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4793.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4793.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7429.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4793.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4793.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3834.81, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4793.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6471.24, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4937.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4793.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Exhaled Air Analysis", "code_information": [ { "code": "94690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 68, "minimum": 20.3349, "maximum": 152.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 145.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.32, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 136.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 136.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 71.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 109.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 92.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Strapping Of Hip", "code_information": [ { "code": "29520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.75, "discounted_cash": 154, "minimum": 36.3576, "maximum": 272.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 272.75, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.59, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 272.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 272.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 246.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 272.75, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 272.75, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 272.75, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 272.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 272.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 272.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 272.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Image-Guided Catheter Fluid Collection Drainage", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2054.48, "discounted_cash": 821, "minimum": 21.83, "maximum": 2054.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1740.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1740.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1312.51, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 854.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1642.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1642.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 862.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1149.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1313.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1680.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1680.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1680.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 656.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2054.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2054.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2054.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2054.48 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 845.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hla I&Li Low Resolution Hla-A -B&-Drb1", "code_information": [ { "code": "81371", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1129.33, "discounted_cash": 404, "minimum": 150.5397, "maximum": 903.464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 857.58, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 857.58, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.55, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 809.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 809.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 424.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 566.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 485.42, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 265.96, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 265.96, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 265.96, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 242.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 242.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 404.52 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 404.52 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 323.62 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 546.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.52, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hexa Gene", "code_information": [ { "code": "81255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 366, "discounted_cash": 51, "minimum": 30.87, "maximum": 292.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 109.07, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.6, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 102.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 102.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 54.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 72.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 61.74, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 86.19, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 86.19, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.19, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 51.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 51.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 51.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.16, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 51.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 51.45 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.16 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Eval Aud Rehab Status, 1St Hr", "code_information": [ { "code": "92626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.75, "discounted_cash": 149, "minimum": 86.4784, "maximum": 519, "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.49, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.19, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 298.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 298.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 208.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 238.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 119.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mra Chest Wo Contrast - C8910 - 61800005", "code_information": [ { "code": "C8910", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3693, "discounted_cash": 276, "minimum": 221.36, "maximum": 2954.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Intro Cath Dialysis Circ Dx Angrph Fluor S&I", "code_information": [ { "code": "36901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3420.65, "discounted_cash": 1825, "minimum": 21.83, "maximum": 13848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3420.65, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3420.65, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1825.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1825.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2917.65, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3420.65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3420.65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1916.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2555.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2920.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3420.65, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3420.65, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3420.65, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1825.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1825.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1825.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2829.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1825.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1825.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1460.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3420.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1825.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3420.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3420.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3420.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2464.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1880.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1825.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri, Cerv Spine", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3604.09, "discounted_cash": 276, "minimum": 221.36, "maximum": 2883.272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 765.7 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 279.86, "10th_percentile": 279.86, "90th_percentile": 279.86, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 1081.23, "10th_percentile": 1081.23, "90th_percentile": 1081.23, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR BILIARY TRACT PROCEDURES - SOI : 2", "code_information": [ { "code": "2612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23558.34, "maximum": 25914.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25914.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25914.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 25914.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 23558.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23558.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23558.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23558.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24265.09, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23558.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Explore Wound,Chest", "code_information": [ { "code": "20101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7138.85, "discounted_cash": 2392, "minimum": 21.83, "maximum": 5711.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5072.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5072.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3824.24, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2488.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4785.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4785.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2512.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3349.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3828.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4895.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4895.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4895.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3708.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1914.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3230.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2464.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Septoplasty/Submucous Resecj W/Wo Cartilage Grf", "code_information": [ { "code": "30520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10995.3, "discounted_cash": 3844, "minimum": 21.83, "maximum": 8796.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8151.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8151.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6145.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3998.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7689.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7689.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4037.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5382.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6151.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5959.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3075.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5190.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3960.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11307, "minimum": 4289.83, "maximum": 20467.3352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20467.34, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 20467.34, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9651.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9651.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11890.19 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 10037.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 19223.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 19223.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 11873.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14700.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 18092.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 15222 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9651.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 4289.83 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 9651.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11307.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14960.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11307.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8844.12 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9651.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11576.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9651.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10189.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 12345.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 10482.17 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15265.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9941.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9651.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Sulfate", "code_information": [ { "code": "84392", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.9, "discounted_cash": 5, "minimum": 3.29, "maximum": 77.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 10.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6.59 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 4.39, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.29 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.29 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.49 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.39 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cystoscopy And Treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19237.5, "discounted_cash": 2424, "minimum": 21.83, "maximum": 15390, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5139.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5139.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "standard_charge_algorithm": "Not To Exceed $9088", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6159.1, "10th_percentile": 6159.1, "90th_percentile": 6159.1, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3874.45, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2521.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4848.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4848.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2545.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3393.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3878.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4959.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4959.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4959.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3757.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1939.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3272.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2496.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Leukocyte Count,Fecal", "code_information": [ { "code": "89055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87, "discounted_cash": 4, "minimum": 2.56, "maximum": 69.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5.12 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.56 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.27 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.42 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Tmj Unilat", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.02, "discounted_cash": 100, "minimum": 46.748, "maximum": 335.216, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 213.93, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.75 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.28, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 104.95, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 201.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 105.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 141.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 161.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.46, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 65.07, "10th_percentile": 65.07, "90th_percentile": 65.07, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 80.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 136.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 103.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Nerv Blck, Intercostal, Single", "code_information": [ { "code": "64420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.95, "discounted_cash": 818, "minimum": 338.0421, "maximum": 2535.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1735.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1735.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 818.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 818.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1308.32, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 851.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1637.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1637.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 859.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1146.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1309.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1674.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1674.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1674.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 818.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 818.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 818.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1268.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 818.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 818.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 654.88, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2535.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 818.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2535.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2535.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2535.95 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1105.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 843.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 818.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 4", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27734.79, "maximum": 30508.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 30508.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 30508.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 30508.27, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 27734.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27734.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27734.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27734.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 28566.83, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 27734.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7817.1, "discounted_cash": 2264, "minimum": 21.83, "maximum": 6253.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4800.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4800.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2264.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2264.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3619.31, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2355.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4529.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4529.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2377.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3170.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3623.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4633.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4633.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4633.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2264.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2264.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2264.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3510.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2264.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2264.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1811.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2264.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3057.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2332.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2264.56, "additional_payer_notes": "100.00% 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": 1078, "minimum": 21.83, "maximum": 2904.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2286.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2286.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1723.64, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1121.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2156.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2156.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1132.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1509.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1725.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2206.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2206.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2206.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1671.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 862.77, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2904.8 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1455.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1110.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1078.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CORONARY INTERVENTION WO AMI - SOI : 3", "code_information": [ { "code": "1753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35599.13, "maximum": 39159.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 39159.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 39159.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 39159.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 35599.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 35599.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 35599.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 35599.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 36667.1, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 35599.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Pml/Raralpha Common Breakpoints Qual/Quant", "code_information": [ { "code": "81315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1412, "discounted_cash": 207, "minimum": 124.39, "maximum": 1129.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 439.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 439.5, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 300.6, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 215.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 414.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 414.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 217.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 290.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 248.77, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 332.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 332.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 332.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 321.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.85, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 124.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 124.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 207.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 207.31 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.85 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 279.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Upper Extremity W/O Contrast", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5684, "discounted_cash": 276, "minimum": 221.36, "maximum": 4547.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 765.7 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 1705.2, "10th_percentile": 1705.2, "90th_percentile": 1705.2, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colorectal Cancer Screen, Sigmoid, Ba Enema - 74270 - 32000239", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1581.37, "discounted_cash": 203, "minimum": 134.4597, "maximum": 1265.096, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 161.2 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 213.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 284.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 325.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 274.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Part removal of ankleheel", "code_information": [ { "code": "28120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21637.5, "discounted_cash": 3794, "minimum": 21.83, "maximum": 17310, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8044.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8044.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6064.57, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3984.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5312.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6071.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5881.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3035.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5122.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3908.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Parathyroid Planar Imaging", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2331.56, "discounted_cash": 463, "minimum": 157.976, "maximum": 1865.248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 982.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 157.98 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 740.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 482.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 927.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 486.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 649.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 741.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 948.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 362.09, "10th_percentile": 362.09, "90th_percentile": 362.09, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 844.52, "10th_percentile": 844.52, "90th_percentile": 844.52, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 718.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 370.89, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 565.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 377.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 625.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.61, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13126.16, "maximum": 14438.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 14438.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 14438.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 14438.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 13126.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13126.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13126.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13126.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13519.95, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 13126.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 3", "code_information": [ { "code": "1143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10117.6, "maximum": 11129.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11129.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11129.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 11129.36, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 10117.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10117.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10117.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10117.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10421.13, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10117.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION - SOI : 4", "code_information": [ { "code": "4654", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21484.28, "maximum": 23632.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23632.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23632.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 23632.71, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 21484.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21484.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21484.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21484.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22128.81, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21484.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Cytopath Tbs C/V Select", "code_information": [ { "code": "88167", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.18, "discounted_cash": 18, "minimum": 9.07, "maximum": 126.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 39.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 37.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 37.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 37.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 37.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 14.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.07 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 15.12 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.21 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NERVOUS SYSTEM MALIGNANCY - SOI : 4", "code_information": [ { "code": "0414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19263.29, "maximum": 21189.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 21189.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 21189.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 21189.62, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 19263.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19263.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19263.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19263.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19841.19, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 19263.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 2", "code_information": [ { "code": "0492", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23330.16, "maximum": 25663.17, "payers_information": [ { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23330.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24030.06, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23330.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25663.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25663.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 25663.17, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 23330.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23330.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23330.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 4", "code_information": [ { "code": "9104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 83472.44, "maximum": 91819.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 91819.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 91819.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 91819.68, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 83472.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 83472.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 83472.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 83472.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 85976.61, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 83472.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc M.Avium-Intra Dna Dir Prob", "code_information": [ { "code": "87560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.61, "discounted_cash": 27, "minimum": 16.37, "maximum": 196.488, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 57.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 54.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 54.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 32.75 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 57.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 57.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 27.29 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 27.29 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.83 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 4", "code_information": [ { "code": "6614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29347.35, "maximum": 32282.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32282.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 32282.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 32282.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 29347.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29347.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29347.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29347.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 30227.77, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 29347.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Open/Perq Placement Intravascular Stnt Same 1St", "code_information": [ { "code": "37238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35672.8, "discounted_cash": 13387, "minimum": 21.83, "maximum": 28538.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28382.03, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 28382.03, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21396.84, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13923.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 26775.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 26775.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 14057.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18742.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 21420.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 27391.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 27391.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 27391.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20751.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10710.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8705 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7645 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 9284 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 7882 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18073.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13789.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13387.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "356", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53622, "minimum": 24818.21, "maximum": 97056.9965, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 97057, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 97057, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43258.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 43258.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 74414.03 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 44988.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 91158.51, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 91158.51, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 56303.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 69709.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 85796.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 93297 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 43258.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 24818.21 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 43258.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 53622.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 67050.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53622.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43581.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 43258.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 72450.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43258.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 63770.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 77260.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 65602.08 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 72390.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 44555.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 43258.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.76, "discounted_cash": 68, "minimum": 3.23, "maximum": 223.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 145.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.32, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.14, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 136.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 136.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 71.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 95.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 109.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 92.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 70.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Irrigat Corpus Cavern,Priapism", "code_information": [ { "code": "54220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1106.1, "discounted_cash": 289, "minimum": 21.83, "maximum": 1106.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 614.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 614.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 463.07, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 579.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 579.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 304.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 405.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 463.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 592.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 592.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 592.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 289.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 289.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 449.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 289.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 231.79, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1106.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 289.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1106.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1106.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1106.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 391.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 289.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES - SOI : 2", "code_information": [ { "code": "2202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25074.21, "maximum": 27581.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27581.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27581.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 27581.63, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 25074.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25074.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25074.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25074.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25826.44, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 25074.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Laryngoscopy Flex Diag", "code_information": [ { "code": "31575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 731, "discounted_cash": 231, "minimum": 21.83, "maximum": 731, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 490.74, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 490.74, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 369.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.74, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 462.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 462.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 243.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 324.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 370.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 473.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 473.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 473.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 731 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 731 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 731 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 731 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 312.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ther Ivnt Cog Funcj Cntct Ea Addl 15 Minutes", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158, "discounted_cash": 19, "minimum": 15.8, "maximum": 158, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 41.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 39.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 39.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 20.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 37.21, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 37.21, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.21, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 158 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 158 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 158 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 158 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Iron Binding Test", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123, "discounted_cash": 8, "minimum": 5.24, "maximum": 98.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 61.5, "10th_percentile": 61.5, "90th_percentile": 61.5, "count": "28" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 10.49 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 28.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 28.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.24 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 18.03, "10th_percentile": 8.74, "90th_percentile": 18.03, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Egd Percutaneous Placement Gastrostomy Tube", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8516.11, "discounted_cash": 2225, "minimum": 21.83, "maximum": 6812.888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4717.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4717.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3556.63, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2314.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4450.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4450.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2336.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3115.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3560.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4553.05, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4553.05, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4553.05, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 1322.55, "10th_percentile": 1322.55, "90th_percentile": 1322.55, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3449.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1780.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3004.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2292.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fats/Lipids, Feces, Quantitative", "code_information": [ { "code": "82710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236, "discounted_cash": 16, "minimum": 10.08, "maximum": 188.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.36, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 20.16 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.58, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "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": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 16.8 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.44 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% 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": 85493, "minimum": 36678.28, "maximum": 154742.5472, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 145338.3, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 145338.3, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 89767.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 111141.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 136788.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 150884 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 68569.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 36678.28 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 68569.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 85493.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 106282.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 85493.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46088 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 68569.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 118299.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 68569.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 104126.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 126153.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 107117.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 115415.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 70626.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 68569.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 154742.55, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 154742.55, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 68569.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 68569.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 121505.54 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 71312.38, "additional_payer_notes": "104.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Homocystine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327.25, "discounted_cash": 17, "minimum": 10.75, "maximum": 261.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 37.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.98, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 35.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 35.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 77.07, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 77.07, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.07, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 14.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 47.97, "10th_percentile": 47.97, "90th_percentile": 47.97, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repr Wnd Intrmd Body/Scalp/Extr 12.5-20 Cm", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1964, "discounted_cash": 471, "minimum": 21.83, "maximum": 1964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 999.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 999.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 753.46, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 490.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 942.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 942.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 495, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 660, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 754.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 964.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 730.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 377.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1964 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1964 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1964 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1964 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 636.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 485.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 471.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL MENINGITIS - SOI : 1", "code_information": [ { "code": "0511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6111.26, "maximum": 6722.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6722.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6722.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 6722.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 6111.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6111.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6111.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6111.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6294.6, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6111.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Fetal Biophys Prof,W/O Nst", "code_information": [ { "code": "76819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1106, "discounted_cash": 121, "minimum": 96.984, "maximum": 884.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 201.5 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mammary Ductogram, Single", "code_information": [ { "code": "77053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1262, "discounted_cash": 276, "minimum": 168.2246, "maximum": 1009.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY W STERILIZATION &OR D&C - SOI : 2", "code_information": [ { "code": "5412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8097.66, "maximum": 8907.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8907.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8907.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 8907.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 8097.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8097.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8097.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8097.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8340.59, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8097.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Acetylcholine Chloride Intraocular For Soln 20 Mg (1:100)", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "24208053920", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "IMPLANTABLE HEART ASSIST SYSTEMS- SOI : 4", "code_information": [ { "code": "1614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 307825.52, "maximum": 338608.07, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 338608.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 338608.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 338608.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 307825.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 307825.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 307825.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 307825.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 317060.28, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 307825.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "022", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39688, "minimum": 32191.7, "maximum": 109184.275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 71836.29, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 71836.29, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 32191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 53825.16 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 33479.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 67470.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 67470.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 41672.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 51595.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 63501.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 85534 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 32191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 32195.56 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 32191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 39688.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49897.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39688.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51612.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 32191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52404.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32191.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46126.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 55884.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 47451.29 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 53579.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33157.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 32191.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Quantitative Screen, Metals", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309, "discounted_cash": 21, "minimum": 13.18, "maximum": 247.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.56, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 46.56, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.84, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 72.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 72.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 21.96 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.57 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Slctv Cath 1Stord W/Wo Art Punct/Fluor/S&I Bila", "code_information": [ { "code": "36252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10164, "discounted_cash": 3661, "minimum": 21.83, "maximum": 8131.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5852.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5126.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5858.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5675.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 1490.04, "10th_percentile": 1490.04, "90th_percentile": 1490.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4943.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Infect Agent Dna/Rna Influenza >2 Types, Ea Add", "code_information": [ { "code": "87503", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.01, "discounted_cash": 29, "minimum": 17.53, "maximum": 226.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 61.95, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.37, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 58.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 30.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 35.06 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 66.65, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 66.65, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.65, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 29.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 29.22 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.38 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Tis Trnfr F/C/C/M/N/A/G/H/F - 14040 - OR36014040", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 2392, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5072.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5072.69, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3824.24, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2488.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4785.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4785.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2512.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3349.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3828.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4895.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4895.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4895.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3708.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1914.22, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3230.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2464.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2392.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Special Stains,Group I", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 60, "minimum": 26.66, "maximum": 160, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 49.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 49.47 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 128.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 96.58, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.85, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 120.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 120.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 63.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 84.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 96.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.64, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 60.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Tenotomy Of Hip Tendon", "code_information": [ { "code": "27001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12191.7, "discounted_cash": 3794, "minimum": 21.83, "maximum": 9753.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8044.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8044.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6064.57, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3984.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5312.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6071.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5881.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3035.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5122.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3908.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Radial Shaft Fx W Manip", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1864, "minimum": 811.4104, "maximum": 4869.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2980.37, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1939.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1958.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2610.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2983.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1491.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3622 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3861 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3280 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1920.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "TONSIL & ADENOID PROCEDURES - SOI : 1", "code_information": [ { "code": "0971", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6817.65, "maximum": 7499.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 7499.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 7499.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 7499.42, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 6817.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7022.18, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Biopsy Soft Tissue Neck/Chest", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7194, "discounted_cash": 1915, "minimum": 21.83, "maximum": 5755.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hiv-1 Ag, Eia", "code_information": [ { "code": "87390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248, "discounted_cash": 24, "minimum": 14.44, "maximum": 198.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 51.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.89, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 48.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 48.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 25.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 28.87 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 58.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 58.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.25, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.44 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 24.06 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophagoscopy Flex Transnasal Diag Wash/Brush", "code_information": [ { "code": "43197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890, "discounted_cash": 1051, "minimum": 21.83, "maximum": 2890, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2229.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2229.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1681.06, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1093.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2103.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2103.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1104.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1472.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1682.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1630.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 841.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1419.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1083.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Coccidioides, Antibody", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161, "discounted_cash": 11, "minimum": 6.88, "maximum": 128.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 13.76 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 37.92, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 37.92, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.92, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.18 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Emg, Needle, One Limb", "code_information": [ { "code": "95860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 652, "discounted_cash": 154, "minimum": 86.9116, "maximum": 652, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 327.09, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.59, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 308.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 246.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 652 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 652 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 652 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 652 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Esophagoscopy Flex Transnasal With Bx Sing/Mult", "code_information": [ { "code": "43198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2890, "discounted_cash": 1051, "minimum": 21.83, "maximum": 2890, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2229.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2229.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1681.06, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1093.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2103.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2103.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1104.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1472.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1682.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1630.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 841.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2890 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1419.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1083.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "738", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20096, "minimum": 8691.4, "maximum": 36375.0089, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 36375.01, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 36375.01, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16631.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16631.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 24876.39 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17297.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34164.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 34164.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 21101.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26125.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 32154.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 29755 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16631.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 8691.4 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 16631.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20096.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 25779.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20096.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20707.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16631.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24219.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16631.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21318.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 25827.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 21930.58 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27130.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17130.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16631.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient New Sf Mdm 15-29 Minutes - G0463 - 76100002", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 591.59, "discounted_cash": 154, "minimum": 41.8562, "maximum": 790.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 327.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 295.8, "10th_percentile": 27.09, "90th_percentile": 415.5, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 308.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 204.9, "10th_percentile": 179.1, "90th_percentile": 249.3, "count": "141" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 86.73, "10th_percentile": 86.73, "90th_percentile": 86.73, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clot Factor Wght Kininogen", "code_information": [ { "code": "85293", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.93, "discounted_cash": 18, "minimum": 11.36, "maximum": 185.544, "payers_information": [ { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 37.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 37.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 54.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 54.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inject Corpora Cavern Xray", "code_information": [ { "code": "54230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439, "minimum": 58.5187, "maximum": 439, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 439 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 439 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 439 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 439 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [ { "code": "687", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15273, "minimum": 6577.7, "maximum": 27645.0893, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27645.09, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 27645.09, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12801.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12801.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17749.73 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13313.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 25965, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 25965, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 16037.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19855.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 24437.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 22793 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12801.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 6577.7 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 12801.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15273.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19842.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15273.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15370.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12801.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17281.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12801.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15210.91 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18428.71 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15647.85 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20619.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13185.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12801.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HEADACHES WITH MCC", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16111, "minimum": 6720.02, "maximum": 29161.9779, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 29161.98, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 29161.98, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 18988.05 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14005.58, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 27389.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 27389.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 16917.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 20945.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 25778.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 26310 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 6720.02 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 13466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16111.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 20873.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16111.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15102.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18487 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13466.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16272.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 19714.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 16739.52 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 21750.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13870.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13466.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KNEE & LOWER LEG PROCEDURES EXCEPT FOOT - SOI : 4", "code_information": [ { "code": "3134", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 50132.92, "maximum": 55146.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 55146.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 55146.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 55146.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 50132.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 50132.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 50132.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 50132.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 51636.91, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 50132.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 4", "code_information": [ { "code": "0424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26037.11, "maximum": 28640.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 28640.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 28640.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 28640.82, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 26037.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26037.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 26037.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 26037.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 26818.22, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 26037.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Bupivacaine Inj 0.5% W/ Epinephrine 1:200000 (Pf)", "drug_information": { "unit": 30, "type": "ML" }, "code_information": [ { "code": "63323046237", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Clsd Treat Talus Fx W Manip", "code_information": [ { "code": "28435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7193.08, "discounted_cash": 1864, "minimum": 958.8376, "maximum": 5754.464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2980.37, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1939.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1958.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2610.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2983.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1491.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1920.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Colon Motility Study Min 6 Hr Cont Record W I&R", "code_information": [ { "code": "91117", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2351.25, "discounted_cash": 250, "minimum": 21.83, "maximum": 2351.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 530.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 530.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.2, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 500.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 500.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 262.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 350.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 400.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 388.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2351.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2351.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2351.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2351.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 338.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 4", "code_information": [ { "code": "9114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 74387.36, "maximum": 81826.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 81826.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 81826.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 81826.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 74387.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 74387.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 74387.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 74387.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 76618.98, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 74387.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Renal Biopsy Perq", "code_information": [ { "code": "50200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7256.1, "discounted_cash": 1915, "minimum": 21.83, "maximum": 5804.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Unilat Select", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4788.91, "discounted_cash": 3661, "minimum": 638.3617, "maximum": 4788.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK - SOI : 3", "code_information": [ { "code": "3423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12091.1, "maximum": 13300.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13300.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13300.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 13300.21, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 12091.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12091.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12091.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12091.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12453.84, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12091.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [ { "code": "580", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23071, "minimum": 9924.29, "maximum": 41759.8856, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 41759.89, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 41759.89, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 29272.32 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 19754.38, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 39221.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 39221.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 24225.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 29993.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 36914.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 38085 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 9924.29 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 23071.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 29441.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23071.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29715.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 28499.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25085.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 30392.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 25805.95 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 31146.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19564.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 18994.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Surg Path,Level V", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1608.72, "discounted_cash": 415, "minimum": 170.05, "maximum": 1286.976, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 881.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 881.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 664.36, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 831.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 831.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 436.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 581.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 665.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 235.21 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 332.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 170.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 235.21 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 229.54, "10th_percentile": 114.77, "90th_percentile": 235.84, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Oxalate", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181, "discounted_cash": 14, "minimum": 8.67, "maximum": 144.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 30.63, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.95, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 28.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 28.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 17.34 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 42.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 42.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 11.56, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.67 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.45 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.56 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR LARGE BOWEL PROCEDURES - SOI : 3", "code_information": [ { "code": "2313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32679.5, "maximum": 35947.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 35947.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 35947.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 35947.45, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 32679.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32679.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 32679.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 32679.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 33659.89, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 32679.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Hepatitis G Dna Dir Probe", "code_information": [ { "code": "87525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.61, "discounted_cash": 29, "minimum": 17.88, "maximum": 196.488, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 57.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 57.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 29.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 29.8 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.84 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 63.18, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.21, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 59.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 59.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 31.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 35.76 } ] } ] }, { "description": "Hc Inject Trigger Point1-2 Muscle", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155, "discounted_cash": 355, "minimum": 21.83, "maximum": 1155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 754.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.93, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 711.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 711.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 373.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 498.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 569.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 728.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 728.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 728.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 284.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 480.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Revj reconstructed breast", "code_information": [ { "code": "19380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10458.13, "discounted_cash": 7700, "minimum": 21.83, "maximum": 10458.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7700.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7700.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8008.59, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 8085.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7700.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 7700.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 7700.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10458.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 7700.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7700.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6160.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6521 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7700.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5729 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6954 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5907 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10395.77, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7931.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7700.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "RENAL DIALYSIS ACCESS DEVICE PROCEDURES- SOI : 1", "code_information": [ { "code": "4441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11311.22, "maximum": 12442.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12442.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12442.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 12442.34, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 11311.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11650.55, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11311.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc M.Tuberculo Dna Dir Probe", "code_information": [ { "code": "87555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.61, "discounted_cash": 26, "minimum": 16.13, "maximum": 196.488, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 56.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.98, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 53.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 53.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 28.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 32.26 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 57.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 57.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.84, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 26.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 26.88 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 4", "code_information": [ { "code": "7704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16332.03, "maximum": 17965.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 17965.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 17965.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 17965.24, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 16332.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16332.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16332.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16332.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 16822, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 16332.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "810", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15259, "minimum": 5755.56, "maximum": 27620.1837, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27620.18, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 27620.18, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12790.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12790.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17729.4 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13302.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 25941.61, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 25941.61, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 16022.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19837.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 24415.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 21903 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12790.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 5755.56 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 12790.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15259.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19825.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15259.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10430.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12790.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17261.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12790.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15193.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18407.6 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15629.92 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20600.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13174.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12790.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nm Pulmonary Ventilation & Perfusion Imaging", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2419.04, "discounted_cash": 629, "minimum": 311.116, "maximum": 1935.232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1334.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1334.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 311.12 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1006.38, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 654.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1259.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1259.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 661.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 881.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1007.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 354.28, "10th_percentile": 354.28, "90th_percentile": 375.68, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 991.21, "10th_percentile": 991.21, "90th_percentile": 991.21, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 976, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 503.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 354.63, "10th_percentile": 354.63, "90th_percentile": 354.63, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 648.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 354.63, "10th_percentile": 354.63, "90th_percentile": 354.63, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR LARGE BOWEL PROCEDURES - SOI : 1", "code_information": [ { "code": "2311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19063.44, "maximum": 20969.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20969.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20969.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 20969.78, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 19063.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19063.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19063.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19063.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19635.34, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 19063.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc X-Ray Guide, Gu Dilation", "code_information": [ { "code": "74485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5631.55, "discounted_cash": 2424, "minimum": 750.6856, "maximum": 5139.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5139.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 5139.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3874.45, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2521.17, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4848.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4848.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2545.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3393.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3878.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4959.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4959.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4959.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3757.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1939.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2689.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2689.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1792.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1792.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3272.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2496.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2424.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "658", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21051, "minimum": 9778.21, "maximum": 38103.5589, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38103.56, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 38103.56, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17390.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 17390.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 26287.49 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 18085.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 35787.87, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 35787.87, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 22104.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27367.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 33682.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 32280 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17390.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 9778.21 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 17390.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 21051.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26954.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21051.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27551.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17390.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25593.84 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17390.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22527.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 27293.06 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 23174.58 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28419.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17912.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17390.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Bone Marrow", "code_information": [ { "code": "77084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3147.76, "discounted_cash": 276, "minimum": 221.36, "maximum": 2518.208, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 833.4 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER SMALL & LARGE BOWEL PROCEDURES - SOI : 2", "code_information": [ { "code": "2232", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18625.19, "maximum": 20487.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20487.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20487.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 20487.7, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 18625.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18625.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18625.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18625.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 19183.94, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18625.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Speech/Hearing Therapy, Group, 30 Min", "code_information": [ { "code": "92508", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 524, "discounted_cash": 26, "minimum": 21.44, "maximum": 838.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 56.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 53.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 53.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 28.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 32.16, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 123.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 123.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 26.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 26.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 26.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 26.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ex For Speech Device Rx Init Hr", "code_information": [ { "code": "92607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.16, "discounted_cash": 135, "minimum": 72.2699, "maximum": 499, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 127.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 127.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.68, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 108.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 287.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 287.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.46, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 271.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 142.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 190.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 162.94, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" } ] } ] }, { "description": "Hc Bronchoscopy Trach Stent", "code_information": [ { "code": "31631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15451.8, "discounted_cash": 8184, "minimum": 21.83, "maximum": 15451.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13080.81, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8511.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 8593.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11458.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 13095.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15451.8, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12685.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6547.61, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11049.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8430.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8184.51, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [ { "code": "902", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25209, "minimum": 11988.05, "maximum": 45629.9371, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 45629.94, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 45629.94, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 20692.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 20692.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 32431.63 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 21520.51, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 42856.85, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 42856.85, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 26470.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 32772.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 40335.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 41096 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 20692.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 11988.05 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 20692.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 25209.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 32073.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25209.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26001.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 20692.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31575.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20692.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27792.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 33672.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 28591.14 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 34033.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21313.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 20692.8, "additional_payer_notes": "100.00% 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, "minimum": 74.3894, "maximum": 558.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 558.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 558.06, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 544.11, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 558.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 558.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 394.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 525.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 450.3, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 131.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 131.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.42, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 558.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% 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": 300.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 225.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 225.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 375.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 375.25 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 300.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 506.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 386.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 375.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Biopsy/Removal Lymph Nodes - 38510 - OR36038510", "code_information": [ { "code": "38510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15664.3, "discounted_cash": 4540, "minimum": 21.83, "maximum": 12531.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9626.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9626.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7257.14, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4722.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9081.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 9081.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4767.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6356.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 7265.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 9290.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9290.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 9290.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 2987.58, "10th_percentile": 2987.58, "90th_percentile": 2987.58, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7038.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3632.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 2256.17, "10th_percentile": 2256.17, "90th_percentile": 2256.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6129.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4676.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ro Radiation Physics Consult", "code_information": [ { "code": "77370", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 823.13, "discounted_cash": 155, "minimum": 109.7232, "maximum": 823.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 330.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 330.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 249.12, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 311.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 311.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 218.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 249.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 318.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 318.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 318.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 127.83, "10th_percentile": 127.83, "90th_percentile": 127.83, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 124.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 823.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 823.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 823.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 823.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Nuclear Therapy, Iv", "code_information": [ { "code": "79101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1516.76, "discounted_cash": 270, "minimum": 202.1841, "maximum": 1213.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 573.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 573.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 354.64 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 432.48, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 281.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 541.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 541.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 284.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 378.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 432.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 553.65, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 553.65, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 553.65, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 419.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 216.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 374.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 270.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 374.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 249.62 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 249.62 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 365.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 278.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 270.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Phleb Veins Extrem < 20", "code_information": [ { "code": "37766", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11803, "discounted_cash": 3661, "minimum": 21.83, "maximum": 9442.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5852.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5126.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5858.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5675.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4943.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 4", "code_information": [ { "code": "0454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24981.4, "maximum": 27479.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 27479.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 27479.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 27479.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 24981.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24981.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24981.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24981.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 25730.84, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 24981.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Multiple Level Spinal Fusion Except Cervical without MCC", "code_information": [ { "code": "448", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51880, "minimum": 41874.1, "maximum": 93902.8543, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 93902.85, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 93902.85, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41874.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 41874.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 71839.15 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 43549.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 88196.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 88196.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 54474.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 67444.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 83008.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 41874.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 41874.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 51880.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 64904.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51880.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57669 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 41874.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 69943.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41874.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61563.69 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 74587.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 63332.11 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 70038.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43130.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 41874.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Excision Of Anal Lesion(S)", "code_information": [ { "code": "46922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18915, "discounted_cash": 3218, "minimum": 21.83, "maximum": 15132, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6824.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 6824.11, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5144.61, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3347.68, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6437.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6437.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3379.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4506.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5150.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6585.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6585.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6585.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3218.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3218.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4989.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3218.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2575.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3218.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4345.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3315.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3218.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Thaw Plasma Fresh Frozen Ea Unit", "code_information": [ { "code": "86927", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 782.89, "discounted_cash": 197, "minimum": 86.1, "maximum": 626.312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.78, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 207.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 276.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 316.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 266.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Excision Breast Lesion", "code_information": [ { "code": "19125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19146.4, "discounted_cash": 4540, "minimum": 21.83, "maximum": 16365.84, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7038.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3632.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6129.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4676.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9626.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9626.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7257.14, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4722.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9081.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 9081.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4767.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6356.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 7265.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 9290.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9290.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 9290.29, "additional_payer_notes": "204.60% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10695.1, "maximum": 11764.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11764.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11764.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 11764.61, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 10695.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10695.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10695.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10695.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11015.95, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10695.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Virus, Not Specified", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 557, "discounted_cash": 12, "minimum": 7.73, "maximum": 445.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 27.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 131.17, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 131.17, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.17, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.73 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.88 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14897, "minimum": 6416.64, "maximum": 26964.4569, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26964.46, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 26964.46, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12502.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12502.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17194.1 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13002.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 25325.73, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 25325.73, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 15642.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19366.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 23835.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 22259 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12502.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 6416.64 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 12502.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14897.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19379.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14897.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11619.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12502.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16740.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12502.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14734.76 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 17851.82 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15158.01 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20111.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12877.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12502.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS - SOI : 3", "code_information": [ { "code": "8933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14242.47, "maximum": 15666.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15666.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15666.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 15666.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 14242.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14242.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14242.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14242.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14669.74, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14242.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Osteot W/Wo Lngth Shrt/Corrj Metar Xcp 1St Ea", "code_information": [ { "code": "28308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14883.3, "discounted_cash": 3794, "minimum": 21.83, "maximum": 18339.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8044.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8044.4, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6064.57, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3946.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7589.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3984.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5312.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6071.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7763.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5881.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3035.62, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5122.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3908.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3794.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 3", "code_information": [ { "code": "7943", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20119.21, "maximum": 22131.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22131.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22131.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 22131.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 20119.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20119.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20119.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20119.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20722.79, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 20119.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bronchoscopy Trach/Bronch Dilat", "code_information": [ { "code": "31630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9959.6, "discounted_cash": 4323, "minimum": 21.83, "maximum": 9166.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9166.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9166.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6910.39, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4496.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8647.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 8647.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4539.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6053.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6918, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8846.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8846.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8846.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6701.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3459, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5837.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4453.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Laryngoscopy Indirect Diagnostic", "code_information": [ { "code": "31505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 731, "discounted_cash": 231, "minimum": 21.83, "maximum": 731, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 490.74, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 490.74, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 369.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.74, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 462.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 462.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 243.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 324.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 370.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 473.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 473.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 473.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.18, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 731 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 731 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 731 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 731 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 312.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 238.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ed Level 1", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 650, "discounted_cash": 97, "minimum": 78.232, "maximum": 650, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 207.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "case rate", "standard_charge_dollar": 650 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 195.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 195.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 102.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 136.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 156.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 200.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 200.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 200.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "HORIZON CASUALTY SERVICES Personal Injury Protection - PIP", "methodology": "case rate", "standard_charge_dollar": 650 }, { "payer_name": "Horizon", "plan_name": "HORIZON CASUALTY SERVICES Workers Comp", "methodology": "case rate", "standard_charge_dollar": 650 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 140 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 97.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 97.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 151.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 97.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.23, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 282 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 97.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 430 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 301 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 443 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 140 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 140 }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 97.79, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES - SOI : 1", "code_information": [ { "code": "3611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17117, "maximum": 18828.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 18828.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 18828.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 18828.69, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 17117, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17117, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17117, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17117, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 17630.51, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17117, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Heart Infarct Image W Ef", "code_information": [ { "code": "78468", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3003.91, "discounted_cash": 629, "minimum": 294.996, "maximum": 2403.128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1334.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1334.92, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 295 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1006.38, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 654.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1259.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1259.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 661.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 881.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1007.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1288.33, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 976, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 503.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 489.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 648.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 629.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Repair Vessel Direct Lower Extrem", "code_information": [ { "code": "35226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2695.55, "discounted_cash": 821, "minimum": 21.83, "maximum": 2695.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1740.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1740.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1312.51, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 854.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1642.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1642.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 862.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1149.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1313.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1680.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1680.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1680.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 656.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2695.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2695.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2695.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2695.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 845.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "URETHRAL & TRANSURETHRAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10474.67, "maximum": 11522.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11522.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11522.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 11522.14, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 10474.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10474.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10474.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10474.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 10788.91, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10474.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 4", "code_information": [ { "code": "3834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21619.58, "maximum": 23781.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23781.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23781.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 23781.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 21619.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21619.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21619.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21619.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 22268.17, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 21619.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.44, "discounted_cash": 11, "minimum": 6.97, "maximum": 135.552, "payers_information": [ { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 13.93 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 39.9, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 39.9, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.9, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 9.29, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.61 } ] } ] }, { "description": "MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL - SOI : 4", "code_information": [ { "code": "6604", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29088.23, "maximum": 31997.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 31997.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31997.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 31997.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 29088.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29088.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29088.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29088.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 29960.88, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 29088.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ORBIT AND EYE PROCEDURES - SOI : 4", "code_information": [ { "code": "0734", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40850.66, "maximum": 44935.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 44935.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 44935.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 44935.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 40850.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 40850.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 40850.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 40850.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 42076.18, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 40850.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Transcath Stent, Cca W/Eps", "code_information": [ { "code": "37215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15255, "minimum": 21.83, "maximum": 12204, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3622 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2090 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3861 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2155 } ] } ] }, { "description": "Rabies Vaccine, Pcec For Inj - 63851050102", "drug_information": { "unit": 1, "type": "EA" }, "code_information": [ { "code": "63851050102", "type": "NDC" }, { "code": "90675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 319, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 40, "median_amount": 60.1, "10th_percentile": 60.1, "90th_percentile": 60.1, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 763.16, "10th_percentile": 763.16, "90th_percentile": 763.16, "count": "1 through 10" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM PROCEDURES - SOI : 2", "code_information": [ { "code": "1802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18290.03, "maximum": 20119.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20119.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20119.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 20119.04, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 18290.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18290.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18290.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18290.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18838.73, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18290.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "595", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27573, "minimum": 12403.17, "maximum": 49908.7771, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 49908.78, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 49908.78, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 22570.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 22570.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 35924.66 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 23473.01, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 46875.65, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 46875.65, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 28952.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 35846.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 44118.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 47426 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 22570.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 12403.17 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 22570.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 27573.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 34983.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27573.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31451.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 22570.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 34976.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22570.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30786.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 37298.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 31670.53 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 37224.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23247.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 22570.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mgmt Methylation Analysis", "code_information": [ { "code": "81287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 486.33, "discounted_cash": 124, "minimum": 64.8278, "maximum": 389.064, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 264.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.73, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.63, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 249.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 249.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 130.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 174.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 149.57, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 114.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 114.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.53, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 99.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 74.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 74.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 124.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 124.64 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 99.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 168.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERM CARDIAC PACEMAKER IMPLANT WO AMI, HEART FAILURE OR SHOCK - SOI : 2", "code_information": [ { "code": "1712", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22876.41, "maximum": 25164.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25164.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25164.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 25164.05, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 22876.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22876.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22876.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 22876.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 23562.7, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 22876.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Tympanometry", "code_information": [ { "code": "92567", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279, "discounted_cash": 43, "minimum": 34.648, "maximum": 279, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 91.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.22, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 86.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 86.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 45.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 60.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 69.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 88.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 88.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 279 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 279 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 279 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 279 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Occult Blood Other Sources", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98, "discounted_cash": 5, "minimum": 3.19, "maximum": 78.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.26 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Audiometry Air & Bone", "code_information": [ { "code": "92553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.75, "discounted_cash": 149, "minimum": 86.4784, "maximum": 648.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 316.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.49, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.19, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 298.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 298.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 156.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 208.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 238.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 305.3, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 119.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 648.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 648.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 648.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 648.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Edg Flex Endoscopic Mucosal Resection", "code_information": [ { "code": "43254", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3575.28, "discounted_cash": 2225, "minimum": 21.83, "maximum": 3575.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3556.63, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2314.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2336.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3115.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3560.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3575.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3449.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1780.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3575.28 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3004.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2292.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Creatine", "code_information": [ { "code": "82540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65, "discounted_cash": 4, "minimum": 2.78, "maximum": 52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5.57 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 3.71, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 4.64 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.71 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Vasopressin Inj 20 Unit/Ml - 42023016401", "drug_information": { "unit": 1, "type": "ML" }, "code_information": [ { "code": "42023016401", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Hla Class I Typing High Resolution Complete", "code_information": [ { "code": "81379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.17, "discounted_cash": 335, "minimum": 117.8599, "maximum": 711.0056, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 711.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 711.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 486.3, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 348.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 670.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 670.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 352.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 469.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 402.46, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 208.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 208.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 208.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 519.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 268.3, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 201.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 201.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 335.38 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 335.38 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 268.3 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 452.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ercp Biliary/Panc Duct Stent Exchnge W/Dil&Wire", "code_information": [ { "code": "43276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6618.67, "discounted_cash": 7040, "minimum": 21.83, "maximum": 6618.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5632.31, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6618.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Topiramate", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168, "discounted_cash": 11, "minimum": 7.15, "maximum": 134.4, "payers_information": [ { "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": 9.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.54 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.4, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 39.56, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 39.56, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.56, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hiv 1 Genotype, Dna/Rna, Other Regions", "code_information": [ { "code": "87906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1811, "discounted_cash": 128, "minimum": 77.24, "maximum": 1448.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 272.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.66, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 257.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 257.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 135.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 180.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 154.48 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 426.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 426.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 426.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 102.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 77.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 77.24 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 128.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 128.73 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.98 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 173.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC", "code_information": [ { "code": "279", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44606, "minimum": 36097.8, "maximum": 80738.4528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 80738.45, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 80738.45, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36097.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 36097.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 61092.42 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 37541.71, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 75831.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 75831.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 46837.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 57988.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 71371.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 69789 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 36097.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 36097.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 44606.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 55951.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44606.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41336.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 36097.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 59480.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36097.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 52354.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 63429.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 53857.98 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 60219.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37180.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 36097.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient Established Minimal Problem(S) - G0463 - 76100006", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 591.59, "discounted_cash": 154, "minimum": 41.8562, "maximum": 790.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 327.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 295.8, "10th_percentile": 27.09, "90th_percentile": 415.5, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.57, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 308.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 308.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 315.88, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 204.9, "10th_percentile": 179.1, "90th_percentile": 249.3, "count": "141" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.51, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 86.73, "10th_percentile": 86.73, "90th_percentile": 86.73, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.39, "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": 31454, "minimum": 14227.85, "maximum": 56932.9708, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 56932.97, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 56932.97, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25652.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 25652.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 41658.85 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 26678.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 53472.96, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 53472.96, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 33027.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 40891.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 50327.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 51977 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 25652.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 14227.85 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 25652.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 31454.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39761.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31454.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26701.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 25652.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40559.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25652.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35700.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 43252.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 36725.69 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 42463.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26421.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 25652.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat C-Mc Disloc W Manip W Anes Ea", "code_information": [ { "code": "26675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6087.1, "discounted_cash": 1864, "minimum": 811.4104, "maximum": 4869.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2980.37, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1939.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1958.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2610.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2983.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1491.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1920.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 4", "code_information": [ { "code": "3044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 88557.67, "maximum": 97413.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 97413.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 97413.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 97413.43, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 88557.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 88557.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 88557.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 88557.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 91214.4, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 88557.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CCMCC", "code_information": [ { "code": "804", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18806, "minimum": 7681.37, "maximum": 34040.5252, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 34040.53, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 34040.53, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 15607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 15607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 22970.64 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 16231.8, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 31971.76, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 31971.76, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 19747.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 24449, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 30091.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 26393 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 15607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 7681.37 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 15607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 18806.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24191.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18806.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15514 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 15607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22364.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15607.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 19685.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 23849.33 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 20250.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 25389.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16075.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 15607.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC", "code_information": [ { "code": "808", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28573, "minimum": 13416.33, "maximum": 51718.2522, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 51718.25, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 51718.25, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23364.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 23364.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 37401.83 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 24298.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 48575.15, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 48575.15, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 30002.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 37145.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 45717.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 47755 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 23364.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 13416.33 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 23364.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 28573.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36214.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28573.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23608 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 23364.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 36414.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23364.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32052.08 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 38832.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 32972.78 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 38574.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24065.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 23364.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS - SOI : 2", "code_information": [ { "code": "4212", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7561.46, "maximum": 8317.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8317.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8317.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 8317.6, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 7561.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7561.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7561.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7561.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7788.3, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7561.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ro Set Radn Therapy Field Simple", "code_information": [ { "code": "77280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 823.13, "discounted_cash": 155, "minimum": 109.7232, "maximum": 823.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 330.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 330.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 249.12, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 162.1, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 311.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 311.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 218.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 249.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 318.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 318.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 318.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 127.83, "10th_percentile": 127.83, "90th_percentile": 127.83, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 124.7, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 823.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 823.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 823.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 823.13 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 120.67, "10th_percentile": 120.67, "90th_percentile": 120.67, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 120.67, "10th_percentile": 120.67, "90th_percentile": 120.67, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 155.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 4", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17591.4, "maximum": 19350.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 19350.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 19350.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 19350.54, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 17591.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17591.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17591.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17591.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18119.14, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 17591.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "NEONATE W ECMO - SOI : 1", "code_information": [ { "code": "5831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 198020.77, "maximum": 217822.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 217822.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 217822.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 217822.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 198020.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 198020.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 198020.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 198020.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 203961.4, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 198020.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 4", "code_information": [ { "code": "7924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 59453.93, "maximum": 65399.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 65399.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 65399.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 65399.33, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 59453.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 59453.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 59453.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 59453.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 61237.55, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 59453.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "POSTPARTUM & POST ABORTION DIAGNOSES WO PROCEDURE - SOI : 3", "code_information": [ { "code": "5613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7413.19, "maximum": 8154.51, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8154.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8154.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 8154.51, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 7413.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7413.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7413.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7413.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7635.59, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7413.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 2", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8386.45, "maximum": 9225.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 9225.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 9225.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 9225.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 8386.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8386.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8386.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8386.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 8638.04, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 8386.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33018, "minimum": 16194.85, "maximum": 59763.3945, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 59763.39, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 59763.39, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 26894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 43969.46 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 27970.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 56131.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 56131.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 34669.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 42923.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 52829.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 55627 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 26894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 16194.85 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 26894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 33018.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41686.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33018.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39628.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42809.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26894.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37680.33 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 45651.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 38762.69 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 44574.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27701.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 26894.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ENDOCRINE DISORDERS - SOI : 3", "code_information": [ { "code": "4243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12698.2, "maximum": 13968.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 13968.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 13968.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 13968.02, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 12698.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12698.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12698.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12698.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 13079.15, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 12698.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ct Scan,Abdomen,W/O Contrast", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2829, "discounted_cash": 121, "minimum": 96.984, "maximum": 2263.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 433.63 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 119.3, "10th_percentile": 119.3, "90th_percentile": 119.3, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 414.73, "10th_percentile": 414.73, "90th_percentile": 414.73, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Abdomen Wo Contrast", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3461.11, "discounted_cash": 276, "minimum": 221.36, "maximum": 2768.888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 765.7 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 537.51, "10th_percentile": 537.51, "90th_percentile": 537.51, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 461.37, "10th_percentile": 461.37, "90th_percentile": 461.37, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Nerv Blck, Trigeminal", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155, "discounted_cash": 355, "minimum": 153.9615, "maximum": 1155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 754.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.93, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 711.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 711.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 373.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 498.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 569.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 728.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 728.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 728.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 179.37, "10th_percentile": 179.37, "90th_percentile": 179.37, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 284.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 480.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Prp I/Hern Init Block >5 Yr", "code_information": [ { "code": "49507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32041.4, "discounted_cash": 4152, "minimum": 21.83, "maximum": 25633.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8802.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8802.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6636.16, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4318.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8304.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 8304.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4359.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5813.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6643.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8495.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8495.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8495.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 5376.49, "10th_percentile": 5376.49, "90th_percentile": 5376.49, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6435.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3321.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5605.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4276.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4152.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Phospholipid Neutraliz, Hexagonal Phospholipid", "code_information": [ { "code": "85598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253, "discounted_cash": 17, "minimum": 10.79, "maximum": 202.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 38.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 35.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 59.58, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 59.58, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.58, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Tetracaine Hcl Inj 1%", "drug_information": { "unit": 2, "type": "ML" }, "code_information": [ { "code": "17478004532", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "344", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32871, "minimum": 18647.52, "maximum": 63239.024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 59497.78, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 59497.78, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 26777.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 26777.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 43752.63 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 27848.81, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 55881.89, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 55881.89, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 34515.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 42733.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 52594.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 59754 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 26777.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 18647.52 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 26777.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 32871.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 41505.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32871.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22622 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 26777.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42598.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 26777.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37494.51 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 45426.29 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 38571.54 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 44376.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 27581.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 26777.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cervical Cancer Screening - G0476 - 31100074 - 31100074", "code_information": [ { "code": "G0476", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245, "discounted_cash": 35, "minimum": 21.05, "maximum": 196, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 74.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.7, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Injection For Lymphatic Xray", "code_information": [ { "code": "38790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1710.1, "minimum": 227.9563, "maximum": 1710.1, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1710.1 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1710.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1710.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1710.1 } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37335.43, "maximum": 41068.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 41068.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 41068.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 41068.97, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 37335.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 37335.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 37335.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 37335.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 38455.49, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 37335.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Urinalysis, Auto, W/Scope", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108, "discounted_cash": 3, "minimum": 1.9, "maximum": 86.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 6.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 54, "10th_percentile": 54, "90th_percentile": 54, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.3, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 25.43, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 25.43, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.43, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 15.83, "10th_percentile": 15.83, "90th_percentile": 32.4, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.17 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.54 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 15.83, "10th_percentile": 14.4, "90th_percentile": 15.83, "count": "66" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43692, "minimum": 21663.88, "maximum": 79082.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 79082.52, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 79082.52, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35371.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 35371.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 59740.6 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 36786.05, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 74276.4, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 74276.4, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 45876.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 56799.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 69907.2, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 76019 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 35371.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 21663.88 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 35371.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 43692, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 54825.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43692, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46834.2 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 35371.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 58164.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35371.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 51195.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 62025.84 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 52666.24 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 58984.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 36432.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 35371.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Self Care Mngment Train Ea 15 Min", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 650, "discounted_cash": 36, "minimum": 28.872, "maximum": 520, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 76.51, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 72.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 72.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 37.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 50.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 153.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 153.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.87, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "100.00% 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, "discounted_cash": 325, "minimum": 112.7718, "maximum": 690.696, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 651.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 342.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 456.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 390.96 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 199.23, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 199.23, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 199.23, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 260.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 195.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 195.48 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 325.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 325.8 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 260.64 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 439.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 690.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 690.7, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 472.41, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 338.83, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 651.6, "additional_payer_notes": "200.00% of Medicare Rates" } ] } ] }, { "description": "INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE - SOI : 4", "code_information": [ { "code": "7104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 53974.29, "maximum": 59371.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 59371.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 59371.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 59371.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 53974.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 53974.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 53974.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 53974.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 55593.52, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 53974.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Platelets Leku Reduced Cmv Neg, Per Unit", "code_information": [ { "code": "P9055", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2110, "discounted_cash": 249, "minimum": 199.408, "maximum": 1688, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 528.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 528.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 398.38, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.23, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 498.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 498.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 261.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 348.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 398.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 509.99, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 509.99, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 509.99, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 249.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 249.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 386.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 249.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 199.41, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 249.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 249.26, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Rbc Antibody Elution", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 197, "minimum": 4.2, "maximum": 418.8696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.78, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 207.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 276.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 316.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 266.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [ { "code": "970", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33497, "minimum": 17402.15, "maximum": 60630.7827, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 60630.78, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 60630.78, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 27274.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 27274.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 44677.56 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 28365.9, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 56946.04, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 56946.04, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 35172.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 43546.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 53596.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 60609 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 27274.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 17402.15 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 27274.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 33497.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42276.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33497.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39454.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 27274.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 43498.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 27274.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 38287.14 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 46386.59 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 39386.93 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 45221.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 28093.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 27274.9, "additional_payer_notes": "100.00% 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, "discounted_cash": 64, "minimum": 38.51, "maximum": 840, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 136.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.08, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 128.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 128.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 67.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 89.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 77.03 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 247.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 247.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 247.28, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 51.35, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.51 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 64.19 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W MAJOR ANOMALY - SOI : 3", "code_information": [ { "code": "6333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23981.09, "maximum": 26379.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 26379.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 26379.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 26379.2, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 23981.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23981.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23981.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23981.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24700.52, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23981.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Arc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511, "discounted_cash": 197, "minimum": 3.11, "maximum": 418.8696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 418.87, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.78, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 205.48, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 395.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 207.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 276.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 316.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.25, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 306.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.14 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 266.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "REHABILITATION WITH CCMCC", "code_information": [ { "code": "945", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21015, "minimum": 8520.35, "maximum": 38037.1681, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 38037.17, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 38037.17, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 17361.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 17361.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 26233.28 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 18055.65, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 35725.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 35725.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 22065.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 27319.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 33624.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 32915 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 17361.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 8520.35 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 17361.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 21015.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26909.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21015.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22698.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 17361.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25541.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17361.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 22481.03 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 27236.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 23126.79 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 28370.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17882.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 17361.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14756, "minimum": 6666.34, "maximum": 26709.2107, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26709.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 26709.21, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16985.74 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 12886.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 25086, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 25086, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 15494.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19183.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 23610.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 17416 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 6666.34 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 12390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14756.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19205.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14756.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11434.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16537.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12390.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14556.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 17635.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 14974.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19921.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12762.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12390.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Calculus Analysis Qual", "code_information": [ { "code": "82355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.5, "discounted_cash": 11, "minimum": 6.95, "maximum": 126, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 24.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 23.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 23.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.09, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 11.58 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 11.58 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Jaw 4+ Vw", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 789.11, "discounted_cash": 121, "minimum": 58.032, "maximum": 631.288, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.03 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 122.55, "10th_percentile": 122.55, "90th_percentile": 122.55, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 2", "code_information": [ { "code": "1312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18331.33, "maximum": 20164.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 20164.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 20164.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 20164.46, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 18331.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18331.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18331.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18331.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 18881.27, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 18331.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [ { "code": "792", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31340, "minimum": 3035.57, "maximum": 56725.4543, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 56725.45, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 56725.45, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 25561.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 25561.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 41489.45 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 26583.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 53278.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 53278.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 32907.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 40742.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 50144.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 53913 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 25561.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 14244.56 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 25561.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 31340.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 39620.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31340.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3035.57 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 25561.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 40394.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 25561.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35555.04 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 43076.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 36576.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 42309.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26328.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 25561.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Wrist Endoscopy/Surgery", "code_information": [ { "code": "29848", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16350, "discounted_cash": 1864, "minimum": 21.83, "maximum": 13080, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2980.37, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1939.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3729.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1958.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2610.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2983.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3815.34, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2890.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1491.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2517.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1920.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1864.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3953.33, "additional_payer_notes": "212.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mra Pelvis Wo Contrast - C8919 - 61800008", "code_information": [ { "code": "C8919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4796, "discounted_cash": 276, "minimum": 221.36, "maximum": 3836.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29579, "minimum": 15051.23, "maximum": 55583, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 53538.12, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 53538.12, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 24162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 38887.46 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 25129.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 50284.42, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 50284.42, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 31058.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38452.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 47326.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 55583 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 24162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 15051.23 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 24162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 29579.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37452.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29579.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35192.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 24162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37861.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24162.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 33325.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 40375.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 34282.49 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 39931.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24887.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 24162.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER AFTERCARE & CONVALESCENCE - SOI : 1", "code_information": [ { "code": "8621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4101.68, "maximum": 4511.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 4511.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 4511.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 4511.85, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 4101.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4101.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4101.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4101.68, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 4224.73, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 4101.68, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Open Bx/Exc Inguinofem Nodes", "code_information": [ { "code": "38531", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17310, "discounted_cash": 4540, "minimum": 21.83, "maximum": 13848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9626.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9626.31, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7257.14, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4722.34, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 9081.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 9081.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4767.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6356.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 7265.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 9290.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9290.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 9290.29, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7038.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3632.57, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 2256.17, "10th_percentile": 2256.17, "90th_percentile": 2256.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6129.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4676.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4540.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH MCC", "code_information": [ { "code": "796", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16640, "minimum": 10809.47, "maximum": 31081.794, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 30118.6, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 30118.6, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 13886.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 13886.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 19768.98 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 14442.06, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 28288.19, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 28288.19, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 17472.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 21632.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 26624.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 30928 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 13886.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 10809.47 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 13886.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 16640.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 21524.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16640.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18982.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 13886.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13886.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 22464.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14303.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 13886.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Immunodiffusion", "code_information": [ { "code": "86329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198, "discounted_cash": 14, "minimum": 8.43, "maximum": 158.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.79, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 29.79, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 16.86 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 46.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 46.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.63, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.24, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 14.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 14.05 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Skin Pinch Graft Procedure <2 Cm", "code_information": [ { "code": "15050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2265.5, "discounted_cash": 857, "minimum": 21.83, "maximum": 2265.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1817.03, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1817.03, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1369.84, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 891.37, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1714.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1714.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 899.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1199.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1371.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1753.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1753.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1753.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1328.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 685.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2265.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2265.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2265.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2265.5 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1157.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 882.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 857.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Debride Necrotic Skin/ Tissue, Genit & Perinm", "code_information": [ { "code": "11004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2520.8, "minimum": 21.83, "maximum": 2520.8, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2520.8 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2090 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2520.8 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2155 } ] } ] }, { "description": "Hc Platelets Pheresis Leukocytes Reduced, Per Unit", "code_information": [ { "code": "P9035", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2499.75, "discounted_cash": 509, "minimum": 333.2167, "maximum": 1999.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1079.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1079.25, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 813.63, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 529.44, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1018.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1018.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 534.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 712.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 814.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1041.58, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1041.58, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1041.58, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 789.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 407.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 687.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15369, "minimum": 6416.64, "maximum": 27819.3923, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 27819.39, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 27819.39, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12877.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12877.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 17892.03 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 13392.91, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 26128.71, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 26128.71, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 16138.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 19980.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 24591.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 22481 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12877.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 6416.64 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 12877.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 15369.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 19960.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15369.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13520.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12877.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17419.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12877.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15332.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 18576.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 15773.29 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 20749.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 13264.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12877.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Peritoneal Lavage W/Wo Imaging Guidance", "code_information": [ { "code": "49084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4898.53, "discounted_cash": 1051, "minimum": 652.974, "maximum": 4842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2229.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2229.86, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1681.06, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1093.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2103.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2103.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1104.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1472.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1682.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2152.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1630.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 841.46, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1419.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1083.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1051.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9497, "minimum": 3689.3, "maximum": 17190.7646, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 17190.76, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 17190.76, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 8214.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 8214.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 9215.36 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 8542.68, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 16146.02, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 16146.02, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 9972.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 12346.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 15196.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 12189 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 8214.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 3689.3 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 8214.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 9497.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12731.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9497.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5733.54 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 8214.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8972.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 8214.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 7897.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 9567.87 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 8124.1 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 12821.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 8460.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 8214.12, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estriol", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340, "discounted_cash": 24, "minimum": 14.51, "maximum": 272, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 80.07, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.07, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 19.34, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.34 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 51.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.06, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.15, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 48.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 48.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 29.02 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 80.07, "additional_payer_notes": "204.60% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11153, "minimum": 4410.93, "maximum": 20187.2015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 20187.2, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 20187.2, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 9528.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 9528.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 11661.5 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 9910.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 18960.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 18960.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 11710.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 14499.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 17845.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 15216 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 9528.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 4410.93 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 9528.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 11153.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14769.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11153.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8052.41 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 9528.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11353.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9528.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 9993.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 12107.58 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 10280.57 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 15056.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 9814.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 9528.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cisatracurium Besylate (Pf) Iv Soln 10 Mg/5Ml - 63323041605", "drug_information": { "unit": 5, "type": "ML" }, "code_information": [ { "code": "63323041605", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Ercp,Biopsy", "code_information": [ { "code": "43261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17140.2, "discounted_cash": 4471, "minimum": 21.83, "maximum": 13712.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9478.88, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9478.88, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7146, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4650.02, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8942.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 8942.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4694.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6259.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 7153.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 9148.01, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 9148.01, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 9148.01, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6930.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3576.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6036.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4605.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4471.17, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Amniocentesis,Diagnostic", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3329.35, "discounted_cash": 1068, "minimum": 21.83, "maximum": 3329.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2264.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 2264.44, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1707.13, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1110.86, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 2136.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 2136.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1121.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1495.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1709.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 2185.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 2185.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 2185.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1068.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1068.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1655.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1068.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 854.5, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3329.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1068.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3329.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3280 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1441.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1100.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1068.13, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE DT MUSCSKEL MALIG - SOI : 1", "code_information": [ { "code": "3431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9429.26, "maximum": 10372.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 10372.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 10372.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 10372.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 9429.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9429.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9429.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9429.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 9712.13, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 9429.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Peri-Px Eval&Program Cardioverter/Defibrillator", "code_information": [ { "code": "93287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 480, "minimum": 63.984, "maximum": 480, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 480 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 480 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 480 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 480 } ] } ] }, { "description": "Hc Tympanometry & Reflex Thresh", "code_information": [ { "code": "92550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 648.75, "discounted_cash": 250, "minimum": 86.4784, "maximum": 648.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 530.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 530.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.2, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 500.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 500.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 262.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 350.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 400.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 388.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 648.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 648.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 648.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 648.75 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 338.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [ { "code": "823", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55823, "minimum": 28244.7, "maximum": 101041.1685, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 101041.17, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 101041.17, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45006.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 45006.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 77666.51 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 46806.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 94900.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 94900.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 58615.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 72571.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 89318.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 98164 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 45006.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 28244.7 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 45006.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 55823.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 69759.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55823.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71229.9 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 45006.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 75617.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 45006.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 66557.54 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 80637.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 68469.4 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 75362.2, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46356.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 45006.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Image Fluid Collxn Drainag Cath Transrec/Vaginal", "code_information": [ { "code": "49407", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8656.34, "discounted_cash": 1915, "minimum": 1153.8901, "maximum": 6925.072, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Urine Bact Cult Id", "code_information": [ { "code": "87088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114, "discounted_cash": 8, "minimum": 4.85, "maximum": 91.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 8.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 9.71 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Med Nutr Ther, Subsq, Indiv, Ea 15 Min", "code_information": [ { "code": "97803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 24, "minimum": 19.264, "maximum": 200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 51.05, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.32, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 48.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 48.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 28.9, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 47.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 47.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 200 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 200 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 200 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Oncoprotein Dcp", "code_information": [ { "code": "83951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 879, "discounted_cash": 64, "minimum": 38.65, "maximum": 703.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 136.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.39, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.99, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 128.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 67.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 77.29 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 207, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 51.53, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 38.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 64.41 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.53 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Surg Path,Gross,Level I", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 33, "minimum": 13.34, "maximum": 160, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 71.08, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 61.07, "10th_percentile": 61.07, "90th_percentile": 61.07, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.59, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.87, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 67.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 67.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 35.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 46.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 53.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 68.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 68.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.34 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.82, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.34 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fecal Blood Scrn Immunoassay", "code_information": [ { "code": "G0328", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.78, "discounted_cash": 18, "minimum": 9.03, "maximum": 154.224, "payers_information": [ { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 14.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 18.05 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 38.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.17, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 36.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 36.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Nonselec", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4788.91, "discounted_cash": 3661, "minimum": 638.3617, "maximum": 4788.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4788.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us,Pregnant Uterus,Transvaginal", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 820, "discounted_cash": 121, "minimum": 96.984, "maximum": 656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 161.2 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 127.35, "10th_percentile": 127.35, "90th_percentile": 127.35, "count": "28" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 120.21, "10th_percentile": 109.31, "90th_percentile": 120.21, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 120.21, "10th_percentile": 109.31, "90th_percentile": 120.21, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Lig/Banding Angioacs Av Fstl", "code_information": [ { "code": "37607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19836.8, "discounted_cash": 3661, "minimum": 21.83, "maximum": 15869.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5852.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5126.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5858.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5675.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4943.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Nose Fx W Stabil", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 3844, "minimum": 1448.7711, "maximum": 8694.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8151.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8151.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6145.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3998.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7689.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7689.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4037.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5382.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6151.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5959.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3075.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5190.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3960.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Phenotype Infect Agent Drug", "code_information": [ { "code": "87900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1834, "discounted_cash": 130, "minimum": 78.21, "maximum": 1467.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 276.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 276.34, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.01, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.56, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 260.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 260.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 136.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 182.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 156.42 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 431.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 431.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 431.91, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 202.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 78.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 78.21 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 130.35 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.28 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 134.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Treat Burn 1St Degree, Initial", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 895.97, "discounted_cash": 232, "minimum": 21.83, "maximum": 895.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 493.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 493.26, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 371.86, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 241.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 465.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 465.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 244.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 325.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 372.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 476.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 476.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 476.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 360.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 186.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 895.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 895.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 895.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 895.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 314.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Blood Typing, Rbc Antigens", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1608.72, "discounted_cash": 415, "minimum": 2.3, "maximum": 1286.976, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 881.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 881.24, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 664.36, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 432.31, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 831.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 831.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 436.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 581.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 665.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 850.48, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 644.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 332.54, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.3 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.83 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.06 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 561.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Mri Brain", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4536, "discounted_cash": 276, "minimum": 221.36, "maximum": 3628.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 765.7 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 704.44, "10th_percentile": 704.44, "90th_percentile": 704.44, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 606.14, "10th_percentile": 606.14, "90th_percentile": 606.14, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Three Catecholamines", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 355, "discounted_cash": 25, "minimum": 15.15, "maximum": 284, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 53.53, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 50.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 50.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 30.3 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 83.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 83.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.6, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.2 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Lymphangiography Pelvic/Abdomin, Bilat", "code_information": [ { "code": "75807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16524.2, "discounted_cash": 3661, "minimum": 2202.6759, "maximum": 13219.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5852.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5126.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5858.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5675.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4943.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Acoustic Reflex Testing", "code_information": [ { "code": "92568", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 43, "minimum": 20.3349, "maximum": 152.55, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 88.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 88.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.65, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 91.82, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.22, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 86.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 86.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 45.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 60.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 69.3, "additional_payer_notes": "160.00% 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": 2189.7, "minimum": 21.83, "maximum": 2189.7, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2189.7 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2189.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2189.7 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2189.7 } ] } ] }, { "description": "Hc Gas Dilut/Washout Lung Vol W/Wo Distrb Vent&Vol", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 699.09, "discounted_cash": 250, "minimum": 93.1887, "maximum": 699.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 530.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 530.85, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 349.55, "10th_percentile": 349.55, "90th_percentile": 349.55, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.2, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 260.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 500.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 500.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 262.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 350.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 400.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 512.32, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 388.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 200.32, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 699.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 699.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 699.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 699.09 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 95.11, "10th_percentile": 93.19, "90th_percentile": 102.49, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 338.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 257.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 250.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CCMCC", "code_information": [ { "code": "537", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14201, "minimum": 5683.77, "maximum": 25704.8779, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 25704.88, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 25704.88, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11950, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11950, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16165.84 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 12428, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 24142.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 24142.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 14911.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18462.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 22722.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 21085 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11950, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 5683.77 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 11950, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14201.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18522.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14201.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13665.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11950, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 15739.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11950, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13853.57 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 16784.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 14251.52 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19172.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12308.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11950, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Duplex Scan Extracranial,Limited", "code_information": [ { "code": "93882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1005.02, "discounted_cash": 121, "minimum": 96.984, "maximum": 1005.02, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1005.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1005.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 1005.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 1005.02 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc St Eval Speech Sound Production Articulate, 75 Min", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 614.25, "discounted_cash": 123, "minimum": 67.2618, "maximum": 1294.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 261.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 261.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.39, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 246.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 246.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 129.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 172.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 148.14, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 144.66, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 144.66, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.66, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 123.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 123.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 191.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 123.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.76, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 468 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 123.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 413 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 499 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 426 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 166.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.45, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28282, "minimum": 16148.03, "maximum": 54762.556, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 51191.18, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 51191.18, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23132.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 23132.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 36971.55 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 24058.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 48080.11, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 48080.11, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 29696.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 36767.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 45251.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 51259 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 23132.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 16148.03 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 23132.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 28282.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 35856, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28282.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29286.6 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 23132.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 35995.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23132.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 31683.35 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 38385.81 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 32593.46 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 38181.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 23826.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 23132.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37036, "minimum": 18395.32, "maximum": 67036.608, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 67036.61, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 67036.61, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 30085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 30085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 49906.93 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 31289.13, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 62962.56, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 62962.56, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 38888.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 48147.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 59258.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 64442 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 30085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 18395.32 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 30085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 37036.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 46632.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37036.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36938.5 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 30085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48590.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 30085.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42768.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 51816.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 43997.06 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 49999.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 30988.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 30085.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12315, "minimum": 5263.65, "maximum": 22291.3446, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 22291.34, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 22291.34, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 10452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 10452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 13379.21 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 10870.29, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 20936.62, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 20936.62, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 12931.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16010.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 19705.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 17366 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 10452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 5263.65 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 10452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 12315.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 16200.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12315.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7736.26 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 10452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 13026.17 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 10452.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11465.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 13891 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 11794.87 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 16626.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 10765.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 10452.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Orbit/Sella/Post Fossa/Ear Wo/W Contr", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3473, "discounted_cash": 203, "minimum": 162.728, "maximum": 2778.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 540.02 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 213.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 284.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 325.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 274.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% 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": 59686, "minimum": 29397.69, "maximum": 108032.1668, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 108032.17, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 108032.17, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48073.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 48073.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 83373.6 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 49996.75, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 101466.68, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 101466.68, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 62670.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 77592.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 95498.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 104812 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 48073.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 29397.69 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 48073.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 59686.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 74514.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 59686.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53013.8 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 48073.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 81173.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 48073.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 71448.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 86562.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 73500.67 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 80576.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 49516.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 48073.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "INTESTINAL OBSTRUCTION - SOI : 4", "code_information": [ { "code": "2474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20910.66, "maximum": 23001.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 23001.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 23001.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 23001.72, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 20910.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20910.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20910.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20910.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21537.98, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 20910.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "MAJOR DEPRESSIVE DISORDERS & OTHERUNSPECIFIED PSYCHOSES - SOI : 2", "code_information": [ { "code": "7512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6164.12, "maximum": 6780.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6780.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6780.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 6780.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 6164.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6164.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6164.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6164.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6349.04, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 6164.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS - SOI : 4", "code_information": [ { "code": "3854", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20160.44, "maximum": 22176.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22176.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22176.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 22176.48, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 20160.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20160.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20160.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20160.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 20765.25, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 20160.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Angio Adrenal Bilat Select", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16524.2, "discounted_cash": 3661, "minimum": 2202.6759, "maximum": 13219.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5852.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5126.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5858.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5675.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4943.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% 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": 90910, "minimum": 47678.15, "maximum": 170070, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 72871.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 72871.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 129509.69 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 75786.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 154547.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 154547.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 95455.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 118183.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 145456.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 170070 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 72871.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 47678.15 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 72871.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 90910.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 112951.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 90910.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 105126 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 72871.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 126092.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 72871.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 110985.37 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 134463.78 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 114173.42 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 122728.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 75057.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 72871.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 164547.37, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 164547.37, "additional_payer_notes": "181.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 3", "code_information": [ { "code": "0573", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14963.09, "maximum": 16459.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 16459.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 16459.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 16459.4, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 14963.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14963.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14963.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14963.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 15411.98, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14963.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 4", "code_information": [ { "code": "2004", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20871.97, "maximum": 22959.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 22959.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 22959.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 22959.16, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 20871.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20871.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20871.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20871.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 21498.13, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 20871.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Shoulder Tum Deep < 5 Cm", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15390, "discounted_cash": 3368, "minimum": 21.83, "maximum": 12312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7141.39, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5383.8, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.32, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 6737.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3537.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4716.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5389.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 6892.11, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5221.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2694.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4547.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3469.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3368.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Sars-Cov-2 Covid-19 Amp Prb", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.37, "discounted_cash": 51, "minimum": 28.0423, "maximum": 168.296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 108.78, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.4, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.36, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 102.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 102.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 53.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 71.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 61.57, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 49.54, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 49.54, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.54, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.05, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 30.79 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 51.31 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 51.31 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.05 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 7.52, "10th_percentile": 7.52, "90th_percentile": 30.84, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Htlv-I Antibody", "code_information": [ { "code": "86687", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.09, "discounted_cash": 9, "minimum": 5.45, "maximum": 157.672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.45, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 46.41, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 46.41, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.41, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES- SOI : 2", "code_information": [ { "code": "0432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13820.99, "maximum": 15203.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15203.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15203.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 15203.09, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 13820.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13820.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13820.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13820.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14235.62, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 13820.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Repair/Graft Achilles Tendon", "code_information": [ { "code": "27652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34620, "discounted_cash": 8415, "minimum": 21.83, "maximum": 27696, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17839.8, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 17839.8, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8415, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8415, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13449.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8751.6, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 16830, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 16830, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 8835.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11781, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 13464, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 17217.09, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 17217.09, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 17217.09, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8415, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 8415, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8415, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13043.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 8415, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8415, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6732, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6521 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8415, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5729 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6954 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5907 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11360.25, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8667.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8415, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Place Cath In Artery, R Heart Or Main Pulm Art", "code_information": [ { "code": "36013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 862, "minimum": 21.83, "maximum": 862, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 862 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 862 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 862 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 862 } ] } ] }, { "description": "ORBIT AND EYE PROCEDURES - SOI : 2", "code_information": [ { "code": "0732", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14229.57, "maximum": 15652.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15652.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15652.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 15652.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 14229.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14229.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14229.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14229.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14656.46, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14229.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Muscle Biopsy", "code_information": [ { "code": "20200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6183.1, "discounted_cash": 1915, "minimum": 21.83, "maximum": 4946.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4060.54, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3061.19, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1991.96, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3830.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2011.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2681.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3064.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3918.81, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2968.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1532.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2585.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1972.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1915.35, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Strapping Of Ankle And/Or Ft", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493, "discounted_cash": 188, "minimum": 65.7169, "maximum": 493, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 399.49, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 301.17, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 195.98, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 376.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 376.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 197.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 263.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 301.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 385.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 385.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 385.55, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 292.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150.75, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 493 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 493 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 493 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 493 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.44, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ph Body Fluid Nos", "code_information": [ { "code": "83986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96, "discounted_cash": 3, "minimum": 2.15, "maximum": 76.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7.59, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 4.3 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.86, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.58 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.58 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.86 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20461, "minimum": 9319.39, "maximum": 37034.8806, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 34784.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 21484.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 26599.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 32738.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 34929 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 16921.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 9319.39 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 16921.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 20461.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 26228.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20461.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22985.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 16921.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 24744.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16921.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 21779.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 26387.28 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 22405.48 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 27622.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17429.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 16921.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 37034.88, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 37034.88, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 16921.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 16921.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 25415.08 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 17598.26, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 34784.14, "additional_payer_notes": "170.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Fingr Articular Fx Wo Manip Ea", "code_information": [ { "code": "26740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1271, "discounted_cash": 286, "minimum": 169.4243, "maximum": 1271, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1271 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1271 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1271 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1271 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Ketamine Hcl Inj 50 Mg/Ml - 42023011410", "drug_information": { "unit": 10, "type": "ML" }, "code_information": [ { "code": "42023011410", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 8.19, "10th_percentile": 0.55, "90th_percentile": 192.65, "count": "78" } ] } ] }, { "description": "Hc Continuous Inhalation Tx, Each Add Hr", "code_information": [ { "code": "94645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.75, "minimum": 47.0216, "maximum": 352.75, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 352.75 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 352.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 352.75 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 352.75 } ] } ] }, { "description": "Hc Eval Fna Smear To Determin Adequacy, First Eval", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 197, "minimum": 26.66, "maximum": 200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.85 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 158.06, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 86.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 143.5 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.85 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 200, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 197.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14265.7, "discounted_cash": 3661, "minimum": 1901.6178, "maximum": 11412.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7762.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5852.29, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3808.18, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7323.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3844.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5126.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 5858.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7491.86, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5675.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2929.37, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4292.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2861.66 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4943.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3771.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3661.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Throat Surgery Procedure", "code_information": [ { "code": "42999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1163.65, "discounted_cash": 274, "minimum": 155.1145, "maximum": 1163.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 582.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 582.3, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 438.99, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285.66, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 549.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 549.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 288.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 384.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 439.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 561.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 561.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 561.97, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "HORIZON CASUALTY SERVICES Personal Injury Protection - PIP", "methodology": "case rate", "standard_charge_dollar": 1012 }, { "payer_name": "Horizon", "plan_name": "HORIZON CASUALTY SERVICES Workers Comp", "methodology": "case rate", "standard_charge_dollar": 966 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 425.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 219.74, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1163.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1163.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1163.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1163.65 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 370.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 274.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Moder Sedate Same Phys/Qhp Each Addl 15 Min", "code_information": [ { "code": "99153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.96, "minimum": 78.6417, "maximum": 471.968, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_algorithm": "Not To Exceed $9088", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 488.43, "10th_percentile": 488.43, "90th_percentile": 488.43, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 91.62, "10th_percentile": 91.62, "90th_percentile": 274.86, "count": "1 through 10" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 86.49, "10th_percentile": 86.49, "90th_percentile": 86.49, "count": "1 through 10" } ] } ] }, { "description": "Hc Mra Pelvis Wo/W Contrast - C8920 - 61800009", "code_information": [ { "code": "C8920", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4782, "discounted_cash": 404, "minimum": 323.664, "maximum": 3825.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 857.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 857.71, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 886.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 646.62, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 420.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 809.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 809.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 424.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 566.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 647.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 827.77, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 627.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.66, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 552.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 368.12 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 546.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 404.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Myelography Lumbar Inj, 2+ Regions", "code_information": [ { "code": "62305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2307, "discounted_cash": 909, "minimum": 21.83, "maximum": 2307, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1927.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1927.29, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1452.96, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1818.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1818.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 954.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1272.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1454.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1860.02, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1409.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 727.28, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2307 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1227.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 936.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 909.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hep B Core Ab Test, Total", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240, "discounted_cash": 12, "minimum": 7.23, "maximum": 192, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "median_amount": 120, "10th_percentile": 120, "90th_percentile": 120, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 56.52, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 56.52, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.52, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Us Exam, Hysterosonography", "code_information": [ { "code": "76831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1752, "discounted_cash": 276, "minimum": 221.36, "maximum": 1401.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 586.6, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 442.23, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 287.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 553.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 290.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 387.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 442.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 566.13, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 428.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 345.2 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 230.13 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.55, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 285, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Egd Flex Intraluminal Tube/Catheter Insertion", "code_information": [ { "code": "43241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8294.05, "discounted_cash": 2225, "minimum": 21.83, "maximum": 6635.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4717.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 4717.72, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3556.63, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2314.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 4450.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 4450.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 2336.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3115.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 3560.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 4553.05, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 4553.05, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 4553.05, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3449.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1780.27, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3004.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2292.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2225.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "423", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50873, "minimum": 24632.81, "maximum": 92080.9264, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 92080.93, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 92080.93, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 41074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 70351.82 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 42717.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 86484.85, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 86484.85, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 53417.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 66135.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 81397.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 85277 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 41074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 24632.81 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 41074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 50873.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 63665.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50873.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 81853 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 41074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 68495.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 41074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 60289.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 73042.96 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 62020.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 68679.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 42306.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 41074.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Inj Nerv Blck, Vagus", "code_information": [ { "code": "64408", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155, "discounted_cash": 355, "minimum": 153.9615, "maximum": 1155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 754.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 754.66, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 568.93, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 370.21, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 711.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 711.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 373.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 498.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 569.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 728.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 728.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 728.31, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 551.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 284.78, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1155 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 480.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 355.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Cath Plc/Cor Angio Rs/I", "code_information": [ { "code": "93454", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14583.8, "discounted_cash": 3759, "minimum": 21.83, "maximum": 11667.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7970.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7970.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 50, "standard_charge_algorithm": "Not To Exceed $9088", "additional_payer_notes": "Not to exceed limits in contract for this procedure", "median_amount": 6029.5, "10th_percentile": 6029.5, "90th_percentile": 6029.5, "count": "1 through 10" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6008.82, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3910.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7519.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7519.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3947.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5263.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6015.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7692.24, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7692.24, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7692.24, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 2264.86, "10th_percentile": 1872.76, "90th_percentile": 2264.86, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5827.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3007.72, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6521 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5729 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6954 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5907 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 1944.02, "10th_percentile": 1944.02, "90th_percentile": 2137.98, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5075.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3872.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Stim/Pacing Heart Post Iv Drug Infu", "code_information": [ { "code": "93623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6973.23, "minimum": 21.83, "maximum": 5578.584, "payers_information": [ { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 1082.94, "10th_percentile": 1082.94, "90th_percentile": 1082.94, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 } ] } ] }, { "description": "Hc Bronchoscopy Distruct Tumor/Stenosis Laser/Cryo", "code_information": [ { "code": "31641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15451.8, "discounted_cash": 4323, "minimum": 21.83, "maximum": 12361.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9166.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 9166.35, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6910.39, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4496.7, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 8647.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 8647.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4539.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6053.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6918, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 8846.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 8846.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 8846.39, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6701.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3459, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5807 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5100 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6192 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5258 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5837.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4453.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4323.75, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Trlml Blln Angiop Open/Perq W/Img S&I Addl Vein", "code_information": [ { "code": "37249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14469.5, "minimum": 21.83, "maximum": 11575.6, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2906 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2546 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3097 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2625 } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [ { "code": "384", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13060, "minimum": 5339.19, "maximum": 23640.1566, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 23640.16, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 23640.16, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 11044, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 11044, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 14480.31 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 11485.76, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 22203.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 22203.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 13713.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 16979.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 20897.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 19095 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 11044, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 5339.19 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 11044, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 13060.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 17118.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13060.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10694.1 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 11044, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14098.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 11044, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12409.13 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 15034.22 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 12765.58 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 17632.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 11375.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 11044, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc X-Ray Thoracic Spine+Swim 3 Vw", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 789.11, "discounted_cash": 121, "minimum": 61.256, "maximum": 631.288, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.26 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 122.55, "10th_percentile": 122.55, "90th_percentile": 122.55, "count": "1 through 10" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PENIS, TESTES & SCROTAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23425.57, "maximum": 25768.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25768.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 25768.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 25768.13, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 23425.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23425.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23425.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23425.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 24128.34, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 23425.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [ { "code": "085", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29307, "minimum": 13608.59, "maximum": 53046.3216, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 49822.51, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 30772.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 38099.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 46891.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 49558 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 23947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 13608.59 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 23947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 29307.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 37117.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29307.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36765.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 23947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 37470.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 23947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32981.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 39958.18 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 33928.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 39564.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 24665.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 23947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 53046.32, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 53046.32, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 23947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 23947, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 38485.99 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 24904.88, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 49822.51, "additional_payer_notes": "170.00% of Medicare Rates" } ] } ] }, { "description": "Hc Collection Capillary Blood Specimen", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "minimum": 1.73, "maximum": 32, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.73 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1.73 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 2.89 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 2.89 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.8 } ] } ] }, { "description": "KIDNEY TRANSPLANT", "code_information": [ { "code": "652", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40285, "minimum": 20691.31, "maximum": 72917.4247, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 72917.42, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 72917.42, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32666.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 32666.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 54707.73 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 33972.74, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 68485.98, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 68485.98, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 42300.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 52371.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 64457.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 65511 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 32666.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 20691.31 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 32666.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 40285.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 50632.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40285.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50709.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 32666.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 53264.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 32666.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 46882.65 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 56800.45 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 48229.35 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 54385.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 33646.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 32666.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 1", "code_information": [ { "code": "9511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14078.77, "maximum": 15486.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 15486.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 15486.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 15486.65, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 14078.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14078.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14078.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14078.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 14501.13, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 14078.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES- SOI : 1", "code_information": [ { "code": "1831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49144.3, "maximum": 54058.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 54058.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 54058.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 54058.73, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 49144.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 49144.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 49144.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 49144.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 50618.63, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 49144.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Phys/Qhp Education Svcs Rendered Pts Grp Setting", "code_information": [ { "code": "99078", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410, "minimum": 54.653, "maximum": 410, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 410 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 410 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 410 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 410 } ] } ] }, { "description": "SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS - SOI : 2", "code_information": [ { "code": "8612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7726.43, "maximum": 8499.07, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 8499.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 8499.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 8499.07, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 7726.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7726.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7726.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7726.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 7958.22, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 7726.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES- SOI : 2", "code_information": [ { "code": "0302", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30662.17, "maximum": 33728.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33728.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 33728.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 33728.39, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 30662.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30662.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 30662.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 30662.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 31582.03, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 30662.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Ct Scan,Maxillofacial Area,W/O Contrast", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2090, "discounted_cash": 121, "minimum": 96.984, "maximum": 1672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 375.6 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 15.53, "median_amount": 324.58, "10th_percentile": 324.58, "90th_percentile": 324.58, "count": "55" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 627, "10th_percentile": 627, "90th_percentile": 627, "count": "1 through 10" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 306.39, "10th_percentile": 278.6, "90th_percentile": 306.39, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 278.6, "10th_percentile": 278.6, "90th_percentile": 306.39, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Spectrophotometry", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98, "discounted_cash": 8, "minimum": 4.86, "maximum": 78.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 4.86 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES - SOI : 2", "code_information": [ { "code": "4412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28591.98, "maximum": 31451.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 31451.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 31451.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 31451.18, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 28591.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28591.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 28591.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28591.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 29449.74, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 28591.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Assay Of Selenium", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359, "discounted_cash": 25, "minimum": 15.32, "maximum": 287.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 54.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.02, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 51.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 51.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 30.64 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 84.54, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 84.54, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.54, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 15.32 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 25.53 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 25.53 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.42 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Genetic Tstg Severe Inhe Cond", "code_information": [ { "code": "81443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.67, "discounted_cash": 2448, "minimum": 18.8846, "maximum": 141.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "A Indicator - 155.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "A Indicator - 120.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 33.36, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 33.36, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.36, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.67, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Post Hip Arthrplas Disloc W Anes", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 999.15, "discounted_cash": 286, "minimum": 133.1867, "maximum": 999.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 999.15 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clot Factor Fletcher Fact", "code_information": [ { "code": "85292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.93, "discounted_cash": 18, "minimum": 11.36, "maximum": 185.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 40.13, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 37.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 37.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 54.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 54.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.62, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 2", "code_information": [ { "code": "0952", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11755.95, "maximum": 12931.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 12931.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 12931.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 12931.55, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 11755.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11755.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11755.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11755.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 12108.63, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 11755.95, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Injt Therap/Proph/Diagnost, Iv Or Ia, Nos", "code_information": [ { "code": "96379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.9, "discounted_cash": 54, "minimum": 23.1809, "maximum": 173.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 115.12, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.47, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 108.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 108.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 57.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 76.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 86.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 111.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 111.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.1, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.44, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 173.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 173.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 173.9 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 173.9 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 73.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Fetal Biophysical Profile, W Nst", "code_information": [ { "code": "76818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1106, "discounted_cash": 121, "minimum": 96.984, "maximum": 884.8, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 169.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 193.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.04, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 163.46 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 108.97 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 163.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 124.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 257.01, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 225.68 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 193.75, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 126.08, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 242.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 127.29, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "Hc Hep A Antibody Total", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174, "discounted_cash": 12, "minimum": 7.43, "maximum": 139.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 26.27, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 24.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 14.87 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 40.98, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 40.98, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.98, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 7.43 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.91 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Nose/Jaw Fracw Dent Wires Fix", "code_information": [ { "code": "21345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5192.75, "discounted_cash": 1799, "minimum": 692.1936, "maximum": 4842, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3814.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 3814.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2875.81, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1871.33, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 3598.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 3598.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 1889.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2519.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 2878.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 3681.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 3681.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 3681.49, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2789.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1439.49, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4541 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3825 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 4842 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3944 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2429.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1853.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1799.36, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Perq Breast Loc Dev Place Mri Guide 1St Lesion", "code_information": [ { "code": "19287", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3773.77, "discounted_cash": 821, "minimum": 503.0435, "maximum": 3773.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1740.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 1740.99, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1312.51, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 854.07, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 1642.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 1642.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 862.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1149.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 1313.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 1680.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 1680.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 1680.22, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1272.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 656.98, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3622 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3181 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3773.77 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 3280 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 845.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 821.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Venous Cutdown <1 Y/O", "code_information": [ { "code": "36420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293, "discounted_cash": 154, "minimum": 39.0569, "maximum": 293, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 293, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 293, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.59, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.46, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 293, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 293, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 162, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 216.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 246.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 293, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 293, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 293, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.43, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 293 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 293 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 293 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 293 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.29, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 154.29, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Office/Outpatient New Sf Mdm 15-29 Minutes - 99202 - 76100002", "code_information": [ { "code": "99202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 591.59, "minimum": 48.86, "maximum": 473.272, "payers_information": [ { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.86 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 3", "code_information": [ { "code": "4703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10860.07, "maximum": 11946.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 11946.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 11946.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 11946.08, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 10860.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10860.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10860.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10860.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 11185.87, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 10860.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Clsd Treat Dental Ridge Fx", "code_information": [ { "code": "21440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10868.5, "discounted_cash": 3844, "minimum": 1448.7711, "maximum": 8694.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8151.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8151.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6145.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3998.72, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7689.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7689.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4037.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5382.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6151.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 7866.71, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5959.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3075.94, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5119 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 4462 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 5458 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 4600 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5190.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3960.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3844.92, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Clsd Treat Scapula Fx Wo Manip", "code_information": [ { "code": "23570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1994, "discounted_cash": 286, "minimum": 228.84, "maximum": 1994, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 606.43, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 457.18, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.49, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 572.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 300.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 400.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 457.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.26, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 443.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.84, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1994 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 1994 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 1994 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 1994 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 386.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITHOUT CCMCC", "code_information": [ { "code": "053", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14487, "minimum": 5706.25, "maximum": 26221.5786, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 26221.58, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 26221.58, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 12176.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 12176.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 16587.65 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 12663.77, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 24628, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 24628, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 15211.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 18833.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 23179.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 21452 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 12176.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 5706.25 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 12176.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 14487.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 18873.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14487.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14292.3 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 12176.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 16149.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 12176.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14215.05 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 17222.17 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 14623.37 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 19557.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 12542, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 12176.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS - SOI : 4", "code_information": [ { "code": "5104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 60793.21, "maximum": 66872.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 66872.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 66872.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 66872.53, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 60793.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 60793.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 60793.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 60793.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 62617, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 60793.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 1", "code_information": [ { "code": "7721", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5832.84, "maximum": 6416.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Better Health - Medi Medi", "methodology": "case rate", "standard_charge_dollar": 6416.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Better Health Medicaid", "methodology": "case rate", "standard_charge_dollar": 6416.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicaid", "methodology": "case rate", "standard_charge_dollar": 6416.12, "additional_payer_notes": "110% of State Medicaid Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "case rate", "standard_charge_dollar": 5832.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UBH", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicaid", "methodology": "case rate", "standard_charge_dollar": 6007.82, "additional_payer_notes": "103% of State Medicaid Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "case rate", "standard_charge_dollar": 5832.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Hc Bilirubin Direct", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71, "discounted_cash": 5, "minimum": 3.01, "maximum": 56.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.01 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.02 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.33, "median_amount": 5.02, "10th_percentile": 5.02, "90th_percentile": 5.02, "count": "1 through 10" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Glucose, Body Fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55, "discounted_cash": 3, "minimum": 2.36, "maximum": 44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "Laboratory - 145.00% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "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": 3.14, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 2.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "UHC (Americhoice)", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Ct Scan Of Leg Combo", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4616.91, "discounted_cash": 203, "minimum": 162.728, "maximum": 3693.528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 431.23, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "AmeriHealth HMO", "methodology": "fee schedule", "standard_charge_dollar": 565.81 }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.1, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 211.55, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 406.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 213.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 284.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 325.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 416.18, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.73, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 267.83 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "fee schedule", "standard_charge_dollar": 178.55 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 274.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 209.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Debride Necrotic Skin/ Tissue, Abd Wall", "code_information": [ { "code": "11005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3251, "minimum": 21.83, "maximum": 3251, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 3251 }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 2090 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 3251 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 2155 } ] } ] }, { "description": "SALIVARY GLAND PROCEDURES", "code_information": [ { "code": "139", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17427, "minimum": 7243.77, "maximum": 31544.1913, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 31544.19, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 31544.19, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 14512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 14512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 20932.76 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 15092.69, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 29627.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 29627.14, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 18299.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 22656.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 27884.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 25898 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 14512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Nj Health - Medicaid", "methodology": "case rate", "standard_charge_dollar": 7243.77 }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 14512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 17427.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 22493.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17427.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20415.7 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 14512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 20380.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 14512.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 17938.66 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 21733.49 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 18453.94 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 23527.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 14947.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 14512.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Percut Remv Kid Stone,2+ Cm", "code_information": [ { "code": "50081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37263.3, "discounted_cash": 10978, "minimum": 21.83, "maximum": 29810.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23273.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 23273.83, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10978.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10978.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17545.83, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11417.35, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 21956.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 21956.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 11527.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15369.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "fee schedule", "standard_charge_dollar": 17565.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ HMO POS", "methodology": "fee schedule", "standard_charge_dollar": 22461.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "fee schedule", "standard_charge_dollar": 22461.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ PPO", "methodology": "fee schedule", "standard_charge_dollar": 22461.44, "additional_payer_notes": "204.60% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10978.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "fee schedule", "standard_charge_dollar": 10978.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "fee schedule", "standard_charge_dollar": 10978.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17016.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "New Jersey Out of State", "plan_name": "New Jersey Out of State", "methodology": "fee schedule", "standard_charge_dollar": 10978.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10978.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8782.58, "additional_payer_notes": "80.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 6521 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "fee schedule", "standard_charge_dollar": 10978.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 5729 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6954 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5907 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14820.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11307.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10978.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52160, "minimum": 6983.4, "maximum": 94411.2471, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 94411.25, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "case rate", "standard_charge_dollar": 94411.25, "additional_payer_notes": "181.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42097.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "case rate", "standard_charge_dollar": 42097.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 72254.18 }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "case rate", "standard_charge_dollar": 43781.09, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "case rate", "standard_charge_dollar": 88673.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "case rate", "standard_charge_dollar": 88673.55, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "case rate", "standard_charge_dollar": 54768.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "case rate", "standard_charge_dollar": 67809.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "plan_name": "FAIRPRICE HEALTHCARE HOLDINGS - FPHH", "methodology": "case rate", "standard_charge_dollar": 83457.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon BCBS Of NJ Indemnity", "methodology": "case rate", "standard_charge_dollar": 82381 }, { "payer_name": "Horizon", "plan_name": "Horizon Medicare", "methodology": "case rate", "standard_charge_dollar": 42097.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Horizon", "plan_name": "Horizon NJ Health Duals (FIDESNP)", "methodology": "case rate", "standard_charge_dollar": 42097.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "HUMANA MILITARY TRICARE", "methodology": "case rate", "standard_charge_dollar": 52160.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Medicare", "methodology": "case rate", "standard_charge_dollar": 65250.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52160.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6983.4 }, { "payer_name": "UBH", "plan_name": "UBH Medicare", "methodology": "case rate", "standard_charge_dollar": 42097.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC All Payer Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 70347.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 42097.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Oxford Commercial (02-01-2023 to 12-31-2026)", "methodology": "case rate", "standard_charge_dollar": 61919.36 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 75018.1 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 63697.99 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 70417.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "case rate", "standard_charge_dollar": 43360.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "case rate", "standard_charge_dollar": 42097.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc R Hrt Cath Chd W/Img Cath Trgt Zon Abnl Nt Connj", "code_information": [ { "code": "93594", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14807.6, "discounted_cash": 3759, "minimum": 21.83, "maximum": 11846.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7970.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "fee schedule", "standard_charge_dollar": 7970.46, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Amerihealth", "plan_name": "Amerihealth HMO Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6008.82, "additional_payer_notes": "159.82% of Medicare Rates" }, { "payer_name": "Clover Health", "plan_name": "Clover Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3910.04, "additional_payer_notes": "104.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Auto", "methodology": "fee schedule", "standard_charge_dollar": 7519.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers comp", "methodology": "fee schedule", "standard_charge_dollar": 7519.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "CURANA", "plan_name": "CURANA", "methodology": "fee schedule", "standard_charge_dollar": 3947.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5263.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "FAIRPRICE HEALTHCARE HOLDINGS - 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Adhoc", "plan_name": "UHC - Adhoc All Payer", "methodology": "case rate", "standard_charge_dollar": 6954 }, { "payer_name": "UHC - Adhoc", "plan_name": "UHC - Adhoc Oxford", "methodology": "case rate", "standard_charge_dollar": 5907 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5075.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3872.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Wellpoint Amerigroup", "plan_name": "Wellpoint Amerigroup Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3759.65, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Drug Test Def 15-21 Classes", "code_information": [ { "code": "G0482", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 831, "discounted_cash": 198, "minimum": 110.7723, "maximum": 664.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 421.33, "additional_payer_notes": "212.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medical Rental Network", "methodology": "